Provider Demographics
NPI:1730645680
Name:YOUR JOURNEY COUNSELING OF DECATUR, LLC
Entity Type:Organization
Organization Name:YOUR JOURNEY COUNSELING OF DECATUR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-786-2013
Mailing Address - Street 1:2220 RINGSMITH DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3619
Mailing Address - Country:US
Mailing Address - Phone:404-786-2013
Mailing Address - Fax:
Practice Address - Street 1:108 E PONCE DE LEON AVE STE 206
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2512
Practice Address - Country:US
Practice Address - Phone:678-636-9761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health