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General NPI Number Information
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NPI Number | 1891143244
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Entity Type | Organization
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Legal Business Name | CHOICES BEHAVIORAL ALTERNATIVES
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 4037 DARLING COURT SUITE B
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City | LILBURN
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State | GA
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Zip | 30047
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Country | US
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Telephone | 770-681-2303
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Fax |
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Provider Business Mailing Address
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Address Line | 1495 WATERCOVE LN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-7041
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Country | US
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Telephone | 770-681-2303
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. LARRY R WYATT
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Credential | LPC,NCC,CSOTS,CAMS,C
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Telephone | 770-681-2303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | GA
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