MEDICARE: INTERLINKED COMMUNITY BEHAVIORAL HEALTH SERVICES 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	101YP2500X	Professional Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1467394817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERLINKED COMMUNITY BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	1257 COMMERCIAL DR SW STE B
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-5991
Country	:	US
Telephone Number	:	770-285-6049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1257 COMMERCIAL DR SW STE B
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-5991
Country	:	US
Telephone Number	:	770-285-6049
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. D'ANTHONY T HARRIS
Credential	:	LPC
Telephone Number	:	770-285-6049

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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