=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962262600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOTPRINTS BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2024
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1055 HOWELL MILL RD NW FL 8
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30318-5557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-504-5336
-----------------------------------------------------
Fax | 912-216-3674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1055 HOWELL MILL RD NW FL 8
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30318-5557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-504-5336
-----------------------------------------------------
Fax | 912-216-3674
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. DARNAE LOVETT
-----------------------------------------------------
Credential | FNP-C, PMHNP-BC
-----------------------------------------------------
Telephone | 912-504-5336
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------