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General NPI Number Information
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NPI Number | 1457637399
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Entity Type | Organization
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Legal Business Name | THE COTTAGES ON MOUNTAIN CREEK, LLC
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 5815 MOUNTAIN CREEK RD NE
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-5036
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Country | US
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Telephone | 404-228-6445
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Fax | 404-963-0555
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Provider Business Mailing Address
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Address Line | 5800 MOUNTAIN CREEK RD NE
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-5035
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Country | US
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Telephone | 404-228-6554
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Fax | 404-963-0555
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. CAROL REYNOLDS
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Credential | MAI, CCIM
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Telephone | 404-786-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | PCH006602
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | PCH006602
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | PCH006602
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License Number State | GA
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