Provider Demographics
NPI:1477734515
Name:CARLA, LTD
Entity Type:Organization
Organization Name:CARLA, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARRA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-357-6928
Mailing Address - Street 1:1049 WILEY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4604
Mailing Address - Country:US
Mailing Address - Phone:678-357-6928
Mailing Address - Fax:
Practice Address - Street 1:70 MANSELL CT
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1523
Practice Address - Country:US
Practice Address - Phone:678-357-6928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC000869261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health