Healthcare Provider Details

I. General information

NPI: 1326813387
Provider Name (Legal Business Name): MENDA BEHAVIORAL HEALTH SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 PENDLETON ST SE
ATLANTA GA
30316-3801
US

IV. Provider business mailing address

1303 PENDLETON ST SE
ATLANTA GA
30316-3801
US

V. Phone/Fax

Practice location:
  • Phone: 323-776-3632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: LESLIE ARIA
Title or Position: PRESIDENT
Credential:
Phone: 916-607-1297