Healthcare Provider Details

I. General information

NPI: 1871450486
Provider Name (Legal Business Name): RIVER FOREST THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 GLENRIDGE DR STE 230
SANDY SPRINGS GA
30328-9929
US

IV. Provider business mailing address

4766 LAUREL WALK
DUNWOODY GA
30338-4751
US

V. Phone/Fax

Practice location:
  • Phone: 504-554-0205
  • Fax:
Mailing address:
  • Phone:
  • 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: BREON GAINES
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 504-554-0205