Provider Demographics
NPI:1275012163
Name:CONNECT 4 BEHAVIORAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:CONNECT 4 BEHAVIORAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAMONICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-899-5871
Mailing Address - Street 1:200 RIVER VISTA DR UNIT 341
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7612
Mailing Address - Country:US
Mailing Address - Phone:678-899-5871
Mailing Address - Fax:
Practice Address - Street 1:1800 LAKE PARK DR SE STE 102
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7639
Practice Address - Country:US
Practice Address - Phone:678-899-5871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003204162AMedicaid