MEDICARE: SEVEN THIRTY ENTERPRISE 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	:	1568320141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEVEN THIRTY ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	214 STATE CAPITOL
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30334
Country	:	US
Telephone Number	:	404-436-1506
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 MARTIN LUTHER KING JR DR SE STE 313
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30334-9053
Country	:	US
Telephone Number	:	404-436-1506
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	TIFFANY JACKSON
Credential	:	LCSW
Telephone Number	:	404-436-1506

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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Directions to “SEVEN THIRTY ENTERPRISE LLC ” Practice Location

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