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General NPI Number Information
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NPI Number | 1477734515
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Entity Type | Organization
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Legal Business Name | CARLA, LTD
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 70 MANSELL CT SUITE 100
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City | ROSWELL
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State | GA
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Zip | 30076-1523
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Country | US
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Telephone | 678-357-6928
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Fax |
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Provider Business Mailing Address
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Address Line | 1049 WILEY BRIDGE RD
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City | WOODSTOCK
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State | GA
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Zip | 30188-4604
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Country | US
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Telephone | 678-357-6928
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. CAROL ANN MARRA
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Credential | LPC
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Telephone | 678-357-6928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | LPC000869
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License Number State | GA
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