Healthcare Provider Details

I. General information

NPI: 1730646019
Provider Name (Legal Business Name): UNITED BEHAVIORAL HEALTH CENTER LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 MELODY DR
POOLER GA
31322-3644
US

IV. Provider business mailing address

101 BLUE MOON CROSSING SUITE 3 BOX 259
POOLER GA
31322
US

V. Phone/Fax

Practice location:
  • Phone: 910-299-2094
  • Fax:
Mailing address:
  • Phone: 910-299-2094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: HEVYLLA LANDING
Title or Position: OWNER
Credential: LMSW
Phone: 910-299-2094