# JEHOVAHS BEHAVIORAL CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GRACE FOMUNUNG SOLE MBR
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619612876
- **Authorized official:** MS. GRACE FOMUNUNG PMHNP (MANAGER)
- **Authorized official phone:** (404) 819-7338

## Contact information

- **Practice address:** 3206 THIMBLEBERRY TRL, DACULA, GA 30019-7299
- **Practice address phone:** (404) 819-7338
- **Mailing address:** 4652 LAWRENCEVILLE HWY NW, LILBURN, GA 30047-3621
- **Mailing address phone:** (404) 819-7338

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/02/2022
- **Last updated:** 11/15/2022