Healthcare Provider Details

I. General information

NPI: 1538617675
Provider Name (Legal Business Name): COMPREHENSIVE CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6916 MCGINNIS FERRY RD SUITE 100
SUWANEE GA
30024-1258
US

IV. Provider business mailing address

6916 MCGINNIS FERRY RD SUITE 100
SUWANEE GA
30024-1258
US

V. Phone/Fax

Practice location:
  • Phone: 404-358-2030
  • Fax:
Mailing address:
  • Phone: 404-358-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number005558
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001464
License Number StateGA

VIII. Authorized Official

Name: JUSTIN GLAESER
Title or Position: PRESIDENT
Credential:
Phone: 404-358-2030