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General NPI Number Information
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NPI Number | 1437657525
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH ASSOICATES OF GEORGIA, LLC
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 320 LANIER AVE W
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1600
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Country | US
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Telephone | 770-376-7635
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Fax | 678-302-0810
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Provider Business Mailing Address
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Address Line | 320 LANIER AVE W
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1600
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Country | US
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Telephone | 770-376-7635
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Fax | 678-302-0810
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Authorized Official
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Title or Position | CEO
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Name | FELICE MARTIN
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Credential | LPC
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Telephone | 770-376-7635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC009575
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License Number State | GA
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