Provider Demographics
NPI:1194330449
Name:GROUNDBREAKING GUIDANCE SERVICES, LLC
Entity type:Organization
Organization Name:GROUNDBREAKING GUIDANCE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EBONI
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-910-9162
Mailing Address - Street 1:500 SUN VALLEY DR STE G3
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5639
Mailing Address - Country:US
Mailing Address - Phone:770-910-9162
Mailing Address - Fax:770-910-9768
Practice Address - Street 1:500 SUN VALLEY DR STE G3
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5639
Practice Address - Country:US
Practice Address - Phone:770-910-9162
Practice Address - Fax:770-910-9768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1184963357OtherPRIVATE INSURANCE
GA1184963357Medicaid