Provider Demographics
NPI:1730667056
Name:BETTER SELF LLC
Entity Type:Organization
Organization Name:BETTER SELF LLC
Other - Org Name:BETTER SELF LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NGONEH
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:401-263-6467
Mailing Address - Street 1:6268 OAKDALE RD SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2836
Mailing Address - Country:US
Mailing Address - Phone:401-263-6467
Mailing Address - Fax:
Practice Address - Street 1:8321 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6936
Practice Address - Country:US
Practice Address - Phone:401-263-6467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETTER SELF LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-30
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW005935261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)