Healthcare Provider Details

I. General information

NPI: 1770930976
Provider Name (Legal Business Name): MONARCH BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5682 PALAZZO WAY SUITE 103
DOUGLASVILLE GA
30134-2500
US

IV. Provider business mailing address

5682 PALAZZO WAY SUITE 103
DOUGLASVILLE GA
30134-2500
US

V. Phone/Fax

Practice location:
  • Phone: 770-577-1200
  • Fax: 470-282-0023
Mailing address:
  • Phone: 770-577-1200
  • Fax: 470-282-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DARVIN R SPELLS
Title or Position: CEO
Credential: M.DIV.
Phone: 770-577-1200