Provider Demographics
NPI:1417415316
Name:TWILYNN JOURDAIN ENTERPRISES, LLC
Entity Type:Organization
Organization Name:TWILYNN JOURDAIN ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO, CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TWILYNN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOURDAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, NCC
Authorized Official - Phone:678-805-1270
Mailing Address - Street 1:6723 PINE VALLEY TRACE
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5818
Mailing Address - Country:US
Mailing Address - Phone:404-375-0625
Mailing Address - Fax:770-498-3891
Practice Address - Street 1:315 W PONCE DE LEON AVE STE 560
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2448
Practice Address - Country:US
Practice Address - Phone:678-805-1270
Practice Address - Fax:770-498-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100714AMedicaid
1174824627OtherNPI