| Full Blossom Behavioral Health Consultants, Llc | |
|
125 Townpark Dr Nw 300 Kennesaw GA 30144-5803 | |
| (888) 310-8388 | |
| (888) 310-8388 |
| Full Name | Full Blossom Behavioral Health Consultants, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 125 Townpark Dr Nw, Kennesaw, Georgia |
| Authorized Official Name and Position | Juanita Elizabeth Brigman (CEO) |
| Authorized Official Contact | 8883108388 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Full Blossom Behavioral Health Consultants, Llc 125 Townpark Dr Nw 300 Kennesaw GA 30144-5803 Ph: (888) 310-8388 | Full Blossom Behavioral Health Consultants, Llc 125 Townpark Dr Nw 300 Kennesaw GA 30144-5803 Ph: (888) 310-8388 |
| NPI Number | 1598117848 |
|---|---|
| Provider Enumeration Date | 07/11/2016 |
| Last Update Date | 07/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598117848 | NPI | - | NPPES |
| 1780009217 | Other | GA | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW004925 (Georgia) | Primary |
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