Healthcare Provider Details

I. General information

NPI: 1811731235
Provider Name (Legal Business Name): RESILIENCE BEHAVIORAL HEALTH GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WESTPARK DR STE 100
PEACHTREE CITY GA
30269-3527
US

IV. Provider business mailing address

1600 PROVIDENCE HWY STE 100
WALPOLE MA
02081-2557
US

V. Phone/Fax

Practice location:
  • Phone: 781-472-0247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DINICOLA
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 781-472-0247