Healthcare Provider Details

I. General information

NPI: 1700709490
Provider Name (Legal Business Name): BRITLIN CLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 TIFFANY LN
LITHONIA GA
30058-5319
US

IV. Provider business mailing address

2136 TIFFANY LN
LITHONIA GA
30058-5319
US

V. Phone/Fax

Practice location:
  • Phone: 470-563-5599
  • Fax:
Mailing address:
  • Phone: 470-563-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN BACCHUS
Title or Position: CEO
Credential:
Phone: 470-563-5599