Healthcare Provider Details

I. General information

NPI: 1811892862
Provider Name (Legal Business Name): LUMEN BEHAVIORAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CHATTAHOOCHEE AVE NW APT 313
ATLANTA GA
30318-3222
US

IV. Provider business mailing address

8735 DUNWOODY PL STE 8331
SANDY SPRINGS GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 404-618-3425
  • Fax:
Mailing address:
  • Phone: 404-618-3425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MIKAYLA ROANE
Title or Position: MEMBER
Credential:
Phone: 404-618-3425