Healthcare Provider Details

I. General information

NPI: 1730818048
Provider Name (Legal Business Name): HILLTOP COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GREATWOOD LN
VILLA RICA GA
30180-5565
US

IV. Provider business mailing address

101 GREATWOOD LN
VILLA RICA GA
30180-5565
US

V. Phone/Fax

Practice location:
  • Phone: 269-421-1788
  • Fax: 678-855-6715
Mailing address:
  • Phone: 269-421-1788
  • Fax: 678-855-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
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: MR. DENARD FENAUD
Title or Position: CEO
Credential: LMSW, MDIV
Phone: 772-408-3907