Provider Demographics
NPI:1700223328
Name:THE JOSHUA GENERATION CARE AND CONSULTANT SERVICES. LLC
Entity Type:Organization
Organization Name:THE JOSHUA GENERATION CARE AND CONSULTANT SERVICES. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-246-2815
Mailing Address - Street 1:4000 BRANTLEY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1559
Mailing Address - Country:US
Mailing Address - Phone:404-838-0788
Mailing Address - Fax:404-973-0790
Practice Address - Street 1:3781 PRESIDENTIAL PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-3702
Practice Address - Country:US
Practice Address - Phone:404-838-0788
Practice Address - Fax:404-973-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007307101YM0800X
GA08020963251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003142232AMedicaid