Organization
DIVERSE DREAMS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA EZEH (CEO)
(706) 883-5885
Entity
Organization
Contact information
Practice address
2959 CHAPEL HILL RD STE D1185, DOUGLASVILLE, GA 30135-1785
(706) 883-5885
Mailing address
5945 AZALEA RIDGE DR, DOUGLASVILLE, GA 30135-5590
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/21/2025
Last updated
07/21/2025
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