Provider Demographics
NPI:1790207181
Name:OSONDU, JOSEPH (CEO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:OSONDU
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 SILVER MOON TRL
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-3969
Mailing Address - Country:US
Mailing Address - Phone:404-259-9737
Mailing Address - Fax:
Practice Address - Street 1:1206 SILVER MOON TRL
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122
Practice Address - Country:US
Practice Address - Phone:404-259-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0033324A101YM0800X, 163WP0807X, 171M00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No171M00000XOther Service ProvidersCase Manager/Care Coordinator