Healthcare Provider Details

I. General information

NPI: 1891411351
Provider Name (Legal Business Name): VALOR BEHAVIORAL HELATH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 W DRUID HILLS DR NE STE 150
BROOKHAVEN GA
30329-2121
US

IV. Provider business mailing address

7620 HIGHWAY 5
DOUGLASVILLE GA
30135-6448
US

V. Phone/Fax

Practice location:
  • Phone: 323-353-7632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN LICHTERMAN
Title or Position: CO- CEO
Credential:
Phone: 323-353-7632