Healthcare Provider Details

I. General information

NPI: 1518445014
Provider Name (Legal Business Name): ENHANCE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3083 VINEVILLE AVE
MACON GA
31204-2460
US

IV. Provider business mailing address

141 WOLF CREEK DR N
MACON GA
31210-9002
US

V. Phone/Fax

Practice location:
  • Phone: 478-258-7798
  • Fax: 888-536-0360
Mailing address:
  • Phone: 478-955-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3852
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC006446
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3852
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3153
License Number StateGA

VIII. Authorized Official

Name: MYRANA CRAIG
Title or Position: DIRECTOR
Credential:
Phone: 478-258-7798