Provider Demographics
NPI:1326455619
Name:ALLIANT BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:ALLIANT BEHAVIORAL HEALTH LLC
Other - Org Name:AID SOCIAL SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEALS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:404-663-8012
Mailing Address - Street 1:5283 BELLS FERRY RD
Mailing Address - Street 2:STE 120
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-2500
Mailing Address - Country:US
Mailing Address - Phone:770-240-0932
Mailing Address - Fax:770-393-6439
Practice Address - Street 1:5283 BELLS FERRY RD
Practice Address - Street 2:STE 120
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-2500
Practice Address - Country:US
Practice Address - Phone:678-393-6439
Practice Address - Fax:404-393-6439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELS IN DISGUISE COUNSELING AND ASSESSMENTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-18
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003136558A101YM0800X, 305R00000X, 343900000X
GALPC4527251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136558AMedicaid