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General NPI Number Information
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NPI Number | 1538810338
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Entity Type | Organization
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Legal Business Name | COUNSELING CENTER AT ROSWELL LLC
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 610 COLONIAL PARK DR
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City | ROSWELL
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State | GA
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Zip | 30075-3746
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Country | US
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Telephone | 470-704-5080
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Fax | 470-704-5081
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Provider Business Mailing Address
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Address Line | PO BOX 27091
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City | NEWARK
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State | NJ
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Zip | 07101-6791
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Country | US
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Telephone | 470-704-5080
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Fax | 470-704-5081
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | JOE BALDASSARRE
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Credential | MBA
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Telephone | 561-318-4468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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