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General NPI Number Information
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NPI Number | 1740058031
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Entity Type | Organization
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Legal Business Name | JOURNEY TO RESILIENCE
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Dates
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Enumeration Date | 12/15/2023
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 4595 TOWNE LAKE PKWY STE 230
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City | WOODSTOCK
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State | GA
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Zip | 30189-5514
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Country | US
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Telephone | 770-262-7943
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Fax |
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Provider Business Mailing Address
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Address Line | 121 BIRCHWOOD PASS
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City | CANTON
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State | GA
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Zip | 30114-7752
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Country | US
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Telephone | 770-262-7943
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LYDIA BISHOP
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Credential |
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Telephone | 770-262-7943
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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 |
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License Number State |
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