MEDICARE: TRINITY INNOVATIVE SUPPORT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1003775990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY INNOVATIVE SUPPORT

Provider Business Mailing Address
First Line	:	605 ATHENS HWY UNIT 5-201
Second Line	:	5-201
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-4767
Country	:	US
Telephone Number	:	404-740-4910
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 ATHENS HWY UNIT 5-201
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-4767
Country	:	US
Telephone Number	:	404-740-4910
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TERESA SNOW
Credential	:	LPC
Telephone Number	:	404-740-4910

Provider Enumeration Date	:	01/17/2026
Last Update Date	:	01/17/2026

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Directions to “TRINITY INNOVATIVE SUPPORT ” Practice Location

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