Provider Demographics
NPI:1922816834
Name:DRAGONFLY23CONSULTING
Entity type:Organization
Organization Name:DRAGONFLY23CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NIN'NUBIYYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANACIUS-EL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-993-1408
Mailing Address - Street 1:5600 SPALDING DR UNIT 921004
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-4709
Mailing Address - Country:US
Mailing Address - Phone:404-993-1408
Mailing Address - Fax:
Practice Address - Street 1:1179 TO LANI FARM RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5328
Practice Address - Country:US
Practice Address - Phone:404-993-1408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No273R00000XHospital UnitsPsychiatric Unit
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No333300000XSuppliersEmergency Response System Companies
No385H00000XRespite Care FacilityRespite Care
No251S00000XAgenciesCommunity/Behavioral Health