Healthcare Provider Details

I. General information

NPI: 1457074403
Provider Name (Legal Business Name): PERSPECTIVE MENTAL HEALTH AND ADDICTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUN VALLEY DR STE G2
ROSWELL GA
30076-5639
US

IV. Provider business mailing address

640 OAKMONT HL
DULUTH GA
30097-5744
US

V. Phone/Fax

Practice location:
  • Phone: 678-488-9563
  • Fax:
Mailing address:
  • Phone: 678-488-9563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONTE RANDALL
Title or Position: OWNER/ SUBSTANCE ABUSE COUNSELOR
Credential: CADCII
Phone: 678-488-9563