Healthcare Provider Details

I. General information

NPI: 1710564109
Provider Name (Legal Business Name): SWARTHY LION BEHAVIORAL HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4854 OLD NATIONAL HWY STE 167
ATLANTA GA
30337-6201
US

IV. Provider business mailing address

4854 OLD NATIONAL HWY STE 167
ATLANTA GA
30337-6201
US

V. Phone/Fax

Practice location:
  • Phone: 470-829-1333
  • Fax: 404-500-5983
Mailing address:
  • Phone: 470-829-1333
  • Fax: 404-500-5983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SINDY VICTOR
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: MS, BCBA, LBA
Phone: 470-829-1333