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General NPI Number Information
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NPI Number | 1730667056
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Entity Type | Organization
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Legal Business Name | BETTER SELF LLC
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 8321 OFFICE PARK DR
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6936
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Country | US
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Telephone | 401-263-6467
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Fax |
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Provider Business Mailing Address
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Address Line | 6268 OAKDALE RD SE
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City | MABLETON
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State | GA
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Zip | 30126-2836
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Country | US
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Telephone | 401-263-6467
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NGONEH BULLARD
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Credential | LCSW
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Telephone | 401-263-6467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | CSW005935
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License Number State | GA
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