Provider Demographics
NPI:1073150934
Name:ONESOURCE LEARNING & DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:ONESOURCE LEARNING & DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALISTS
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-484-3879
Mailing Address - Street 1:4002 HIGHWAY 78 W STE 530-347
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-7915
Mailing Address - Country:US
Mailing Address - Phone:770-558-3920
Mailing Address - Fax:404-891-4788
Practice Address - Street 1:2165 W PARK CT STE I
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3564
Practice Address - Country:US
Practice Address - Phone:770-558-3920
Practice Address - Fax:404-891-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty