Provider Demographics
NPI:1467646257
Name:JOURNEY OF SELF DISCOVERY, LLC.
Entity Type:Organization
Organization Name:JOURNEY OF SELF DISCOVERY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FAMILY THERAPIST/LIFE COACH
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-882-4240
Mailing Address - Street 1:5295 SILVER CREEK DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5359
Mailing Address - Country:US
Mailing Address - Phone:770-882-4240
Mailing Address - Fax:
Practice Address - Street 1:4319 COVINGTON HWY
Practice Address - Street 2:SUITE 319
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1210
Practice Address - Country:US
Practice Address - Phone:770-882-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003554251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA185548077AMedicaid