MEDICARE: ALLIANCE BEHAVIORAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1093564825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	823 BROAD ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-1214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	823 BROAD ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-1214
Country	:	US
Telephone Number	:	803-221-0441
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	CARLOS FOSTER
Credential	:
Telephone Number	:	803-221-0441

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	05/14/2024

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