Provider Demographics
NPI:1235609355
Name:TEEN DREAMS INCORPORATED
Entity Type:Organization
Organization Name:TEEN DREAMS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEEKA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-341-5210
Mailing Address - Street 1:436 EDISTO DR
Mailing Address - Street 2:
Mailing Address - City:BELVEDERE
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2726
Mailing Address - Country:US
Mailing Address - Phone:803-624-3806
Mailing Address - Fax:
Practice Address - Street 1:716 BROAD ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5003
Practice Address - Country:US
Practice Address - Phone:803-624-3806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health