MEDICARE: D.R.E.A.M THERAPUETIC SOLUTIONS, 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	251S00000X	Community/Behavioral Health Agency	LPC005863	GA

General Provider Information

NPI Number	:	1750697694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D.R.E.A.M THERAPUETIC SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 490670
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-0670
Country	:	US
Telephone Number	:	404-295-4224
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 FLAT SHOALS RD APT 2204
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-4374
Country	:	US
Telephone Number	:	404-295-4224
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS KIMBERLY LORELLE TAYLOR
Credential	:	LPC
Telephone Number	:	404-295-4224

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/30/2010

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