Healthcare Provider Details

I. General information

NPI: 1609356914
Provider Name (Legal Business Name): PYRAMID FAMILY BEHAVIORAL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11138 STATE BRIDGE RD STE 100A
JOHNS CREEK GA
30022-7465
US

IV. Provider business mailing address

11138 STATE BRIDGE RD STE 100A
JOHNS CREEK GA
30022-7465
US

V. Phone/Fax

Practice location:
  • Phone: 770-776-8177
  • Fax:
Mailing address:
  • Phone: 814-552-0229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON HENDRICKS
Title or Position: CEO
Credential:
Phone: 814-940-0407