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General NPI Number Information
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NPI Number | 1164888731
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Entity Type | Organization
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Legal Business Name | LOTUS BEHAVIORAL HEALTH AND WELLNESS
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 1786 CENTURY BLVD NE STE A
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City | ATLANTA
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State | GA
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Zip | 30345-3320
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Country | US
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Telephone | 404-764-8904
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Fax |
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Provider Business Mailing Address
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Address Line | 186 DAISY MEADOW TRL
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-4683
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ADRIENNE SLAUGHTER
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Credential |
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Telephone | 404-764-8904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005205
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License Number State | GA
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