Provider Demographics
NPI:1396237731
Name:BEAUTIFUL DREAMERS
Entity type:Organization
Organization Name:BEAUTIFUL DREAMERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL-CONSTANTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-613-1242
Mailing Address - Street 1:4330 S LEE ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5796
Mailing Address - Country:US
Mailing Address - Phone:678-613-1242
Mailing Address - Fax:
Practice Address - Street 1:4330 S LEE ST STE 200A
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5796
Practice Address - Country:US
Practice Address - Phone:470-326-5176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2328431L101Y00000X, 101YM0800X
101YM0800X
GA444521252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency