Healthcare Provider Details

I. General information

NPI: 1750061206
Provider Name (Legal Business Name): ABBY BEHAVIORAL HEALTH AND PSYCHOTHERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 FOUNTAIN DR STE D
SNELLVILLE GA
30078-2900
US

IV. Provider business mailing address

2121 FOUNTAIN DR STE D
SNELLVILLE GA
30078-2900
US

V. Phone/Fax

Practice location:
  • Phone: 470-435-5341
  • Fax:
Mailing address:
  • Phone: 470-435-5341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. OLUFUNMILAYO TEMITOPE AJALA
Title or Position: NURSE PRACTITIONER
Credential: APRN, PMHNP -BC
Phone: 470-435-5341