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General NPI Number Information
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NPI Number | 1730646019
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Entity Type | Organization
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Legal Business Name | UNITED BEHAVIORAL HEALTH CENTER LLC.
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 59 MELODY DR
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City | POOLER
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State | GA
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Zip | 31322-3644
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Country | US
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Telephone | 910-299-2094
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Fax |
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Provider Business Mailing Address
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Address Line | 101 BLUE MOON CROSSING SUITE 3 BOX 259
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City | POOLER
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State | GA
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Zip | 31322
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Country | US
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Telephone | 910-299-2094
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEVYLLA LANDING
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Credential | LMSW
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Telephone | 910-299-2094
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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