Provider Demographics
NPI:1316007180
Name:MANNA TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:MANNA TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR, PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:678-495-9775
Mailing Address - Street 1:2250 SATELLITE BLVD
Mailing Address - Street 2:SUITE # 115
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4906
Mailing Address - Country:US
Mailing Address - Phone:678-495-9775
Mailing Address - Fax:678-495-9745
Practice Address - Street 1:2250 SATELLITE BLVD
Practice Address - Street 2:SUITE # 115
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4906
Practice Address - Country:US
Practice Address - Phone:678-495-9775
Practice Address - Fax:678-495-9745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)