Straight Street Life Center Inc

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Legal business name

STRAIGHT STREET LIFE CENTER INC

Practice address

12461 Veterans Memorial
Douglasville, GA 30134

Phone

(770) 225-4701

NPI assigned

Apr 15, 2019

Last updated

Apr 15, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Jessica L Frazier, BA, CERTIFIED LIFE C

Title

Executive Director

Phone

(404) 951-3969

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555286400000",
    "number": "1598328791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12461 VETERANS MEMORIAL",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "30134",
            "telephone_number": "770-225-4701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12461 VETERANS MEMORIAL",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "30134",
            "telephone_number": "770-225-4701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STRAIGHT STREET LIFE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-15",
        "last_updated": "2019-04-15",
        "status": "A",
        "authorized_official_last_name": "FRAZIER",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "404-951-3969",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "BA, CERTIFIED LIFE C"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lavon Patrice Sturkey

• Peer Specialist in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Peer Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.