Provider Demographics
NPI:1417342718
Name:NEXTSTEPTOWARDSUCCESS
Entity Type:Organization
Organization Name:NEXTSTEPTOWARDSUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:TALIB
Authorized Official - Middle Name:A
Authorized Official - Last Name:EL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-840-8335
Mailing Address - Street 1:8330 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6937
Mailing Address - Country:US
Mailing Address - Phone:404-840-8335
Mailing Address - Fax:770-635-8101
Practice Address - Street 1:8330 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6937
Practice Address - Country:US
Practice Address - Phone:404-840-8335
Practice Address - Fax:770-635-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003134875AMedicaid