Organization
BUILDING A SOLID FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE ASHLOCK PHD ED.D (CEO)
(770) 469-3211
Entity
Organization
Contact information
Practice address
961 N HAIRSTON RD, 230A, STONE MOUNTAIN, GA 30083-2854
(770) 469-3211
Mailing address
961 N HAIRSTON RD, 230A, STONE MOUNTAIN, GA 30083-2854
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053985334
DRIVER LICENSE
GA
Enumeration date
10/25/2011
Last updated
10/25/2011
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