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General NPI Number Information
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NPI Number | 1902399686
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Entity Type | Organization
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Legal Business Name | BLUEPRINT THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 315 W PONCE DE LEON AVE STE 645
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City | DECATUR
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State | GA
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Zip | 30030-2480
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Country | US
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Telephone | 470-332-0606
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Fax |
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Provider Business Mailing Address
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Address Line | 275 13TH ST NE APT 310
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City | ATLANTA
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State | GA
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Zip | 30309-3698
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Country | US
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Telephone | 770-367-5270
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH BAYNES
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Credential | LCSW
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Telephone | 470-332-0605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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