MEDICARE: THE COUNSELING CENTER AT ROSWELL GA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1255272282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COUNSELING CENTER AT ROSWELL GA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1575
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 E CROSSVILLE RD STE 105
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-5807
Country	:	US
Telephone Number	:	470-704-5080
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ISIDORE BLEIER
Credential	:
Telephone Number	:	732-948-9995

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	04/03/2026

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