Organization
BIG MAMA HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HANNIYAH ABDUL AZIZ (CEO/OWNER)
(404) 538-6074
Entity
Organization
Contact information
Practice address
707 PENNYBROOK LN, STONE MOUNTAIN, GA 30087-5918
(404) 538-6074
Mailing address
707 PENNYBROOK LN, STONE MOUNTAIN, GA 30087-5918
(404) 538-6074
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/17/2015
Last updated
06/17/2015
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