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General NPI Number Information
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NPI Number | 1659924751
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN BEHAVIORAL HEALTH AND CONSULTING
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 53 POPLAR ST
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City | NEWNAN
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State | GA
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Zip | 30263-1039
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Country | US
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Telephone | 404-516-1996
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Fax |
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Provider Business Mailing Address
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Address Line | 2997 COBB PKWY SE UNIT 725575
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City | ATLANTA
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State | GA
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Zip | 31139-2703
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Country | US
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Telephone | 404-516-1996
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Fax |
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Authorized Official
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Title or Position | CHIEF MANAGING OFFICER
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Name | MICHELLE MITCHELL
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Credential |
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Telephone | 404-516-1996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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