Healthcare Provider Details

I. General information

NPI: 1033013248
Provider Name (Legal Business Name): VANTAGE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E TAYLOR ST STE B
GRIFFIN GA
30223-3413
US

IV. Provider business mailing address

120 E TAYLOR ST STE B
GRIFFIN GA
30223-3413
US

V. Phone/Fax

Practice location:
  • Phone: 404-999-4061
  • Fax: 770-215-5763
Mailing address:
  • Phone: 404-999-4061
  • Fax: 770-215-5763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. VALERIEN DIANE MOORE
Title or Position: OWNER/PROVIDER
Credential: DNP, PMHNP-BC
Phone: 404-999-4061