Healthcare Provider Details

I. General information

NPI: 1326455619
Provider Name (Legal Business Name): ALLIANT BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5283 BELLS FERRY RD STE 120
ACWORTH GA
30102-2500
US

IV. Provider business mailing address

5283 BELLS FERRY RD STE 120
ACWORTH GA
30102-2500
US

V. Phone/Fax

Practice location:
  • Phone: 678-393-6439
  • Fax: 404-393-6439
Mailing address:
  • Phone: 770-240-0932
  • Fax: 770-393-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number003136558A
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number003136558A
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number003136558A
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLPC4527
License Number StateGA

VIII. Authorized Official

Name: MS. YOLANDA SEALS
Title or Position: CEO
Credential: LPC, LMFT
Phone: 404-663-8012