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General NPI Number Information
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NPI Number | 1952179384
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Entity Type | Organization
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Legal Business Name | YELLOW BRICK ROAD LLC
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 2775 CRUSE RD STE 601
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7142
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Country | US
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Telephone | 678-330-7298
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Fax |
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Provider Business Mailing Address
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Address Line | 2440 WISTERIA DR UNIT 769
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City | SNELLVILLE
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State | GA
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Zip | 30078-1967
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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 | DIRECTOR
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Name | MS. LAKEISHA WILSON
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Credential |
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Telephone | 678-330-7298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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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 | 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 #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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