MEDICARE: CJ FAMILY & CONSULTING SERVICES, LLC

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	:	1164020814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CJ FAMILY & CONSULTING SERVICES, LLC

Provider Business Mailing Address
First Line	:	HARBOR POINTE PKWY
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-5838
Country	:	US
Telephone Number	:	678-433-6808
Fax Number	:

Provider Business Practice Location Address
First Line	:	HARBOR POINTE PKWY
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-5838
Country	:	US
Telephone Number	:	678-433-6808
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	JESAIRA GLOVER
Credential	:	LAPC
Telephone Number	:	470-309-2703

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	11/20/2020

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