Provider Demographics
NPI:1922659580
Name:PRESTIGIOUS THERAPY CONSULTING SERVICES
Entity Type:Organization
Organization Name:PRESTIGIOUS THERAPY CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MYAH
Authorized Official - Middle Name:NAKEYA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-544-9292
Mailing Address - Street 1:1872 SIMMONS LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-5348
Mailing Address - Country:US
Mailing Address - Phone:678-544-9292
Mailing Address - Fax:
Practice Address - Street 1:1872 SIMMONS LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-5348
Practice Address - Country:US
Practice Address - Phone:678-544-9292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty