Healthcare Provider Details

I. General information

NPI: 1003615972
Provider Name (Legal Business Name): THE EMOTIONAL HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WHITE ROCKS WAY
CONYERS GA
30012-7126
US

IV. Provider business mailing address

1420 WHITE ROCKS WAY
CONYERS GA
30012-7126
US

V. Phone/Fax

Practice location:
  • Phone: 404-453-9497
  • Fax:
Mailing address:
  • Phone: 404-453-9497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: VERONICA LEANA BENTLEY
Title or Position: OWNER
Credential: LPC
Phone: 404-453-9497