1417667809 NPI number — JESSRAW BEAUTY

Table of content: ALYSSA ARNSPERGER MSW, LMSW (NPI 1780564674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417667809 NPI number — JESSRAW BEAUTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JESSRAW BEAUTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417667809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
386 SHERWOOD CIR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONYERS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30094-4355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-769-3399
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1253 CAROLINE ST NE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30307-2759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-769-3399
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BETTERSON
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
678-769-3399

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)