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NPI Code Detail

MEDICARE: RIDGELINE COUNSELING LLC

MEDICARE: RIDGELINE COUNSELING 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
1251S00000XCommunity/Behavioral Health Agency3565GA

General Provider Information

NPI Number : 1508058389
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIDGELINE COUNSELING LLC
Provider Business Mailing Address
First Line : 2440 SANDY PLAINS ROAD
Second Line : BUILDING 21 SUITE 200
City : MARIETTA
State : GA
Zip : 30066-7233
Country : US
Telephone Number : 770-993-9700
Fax Number : 770-993-9800
Provider Business Practice Location Address
First Line : 2440 SANDY PLAINS ROAD
Second Line : BUILDING 21 SUITE 200
City : MARIETTA
State : GA
Zip : 30066-7233
Country : US
Telephone Number : 770-993-9700
Fax Number : 770-993-9800
Authorized Official
Title or Position : OWNER
Name : DAVID GLENN MARKWELL
Credential :
Telephone Number : 770-993-9700
Provider Enumeration Date : 08/15/2007
Last Update Date : 12/12/2025

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