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General NPI Number Information
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NPI Number | 1770323263
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Entity Type | Organization
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Legal Business Name | OPTIMUM GLOW TREATMENT CENTER LLC
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 2245 GODBY RD STE 202
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City | ATLANTA
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State | GA
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Zip | 30349-5059
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Country | US
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Telephone | 470-452-4317
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Fax |
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Provider Business Mailing Address
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Address Line | 5050 UNION ST UNIT 73
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City | UNION CITY
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State | GA
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Zip | 30291-2700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DENIKA WORKMAN
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Credential |
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Telephone | 470-452-4317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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