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General NPI Number Information
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NPI Number | 1770618092
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH WELLNESS CENTER INC
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2470 WINDY HILL ROAD SUITE 366C
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City | MARIETTA
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State | GA
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Zip | 30067
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Country | US
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Telephone | 678-548-0557
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Fax | 770-926-6184
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Provider Business Mailing Address
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Address Line | 4706 JAMERSON FOREST CIRCLE
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City | MARIETTA
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State | GA
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Zip | 30066
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Country | US
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Telephone | 678-548-0557
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Fax | 770-926-6184
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Authorized Official
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Title or Position | THERAPIST CEO
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Name | MS. JACQUELINE MOORE
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Credential |
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Telephone | 678-548-0557
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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 | LMSW1840
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License Number State | GA
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