Provider Demographics
NPI:1598141673
Name:YOUR JOURNEY TO FINDING PEACE
Entity Type:Organization
Organization Name:YOUR JOURNEY TO FINDING PEACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:REID-HAYLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-392-0727
Mailing Address - Street 1:4535 WOODLAND BANK BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8866
Mailing Address - Country:US
Mailing Address - Phone:678-392-0727
Mailing Address - Fax:470-300-7773
Practice Address - Street 1:1585 OLD NORCROSS RD STE 201F
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4043
Practice Address - Country:US
Practice Address - Phone:678-392-0727
Practice Address - Fax:470-300-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0055601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003203430AMedicaid