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General NPI Number Information
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NPI Number | 1730679127
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Entity Type | Organization
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Legal Business Name | OLIVET BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 8336 OFFICE PARK DR STE K
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6937
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Country | US
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Telephone | 678-458-1759
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Fax |
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Provider Business Mailing Address
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Address Line | 3002 OLDE TABBY DR
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-9223
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Country | US
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Telephone | 678-458-1759
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | DR. DARREN LEE COOPER
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Credential | LCSW
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Telephone | 678-458-1759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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