Healthcare Provider Details

I. General information

NPI: 1316591811
Provider Name (Legal Business Name): ROCKRIDGE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 JONES BRIDGE RD STE 301
JOHNS CREEK GA
30022-4560
US

IV. Provider business mailing address

11030 JONES BRIDGE RD STE 301
JOHNS CREEK GA
30022-4560
US

V. Phone/Fax

Practice location:
  • Phone: 561-568-1770
  • Fax:
Mailing address:
  • Phone: 561-568-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. ROOPA CRAWFORD
Title or Position: CO-OWNER
Credential: PSY.D
Phone: 561-568-1770