Provider Demographics
NPI:1497223143
Name:NOT BY BREAD ALONE
Entity Type:Organization
Organization Name:NOT BY BREAD ALONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:770-842-2435
Mailing Address - Street 1:2143 SABLESHIRE WAY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6476
Mailing Address - Country:US
Mailing Address - Phone:770-842-2435
Mailing Address - Fax:
Practice Address - Street 1:2727 BOULDERCREST RD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-4811
Practice Address - Country:US
Practice Address - Phone:770-842-2435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOT BY BREAD ALONE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty