Provider Demographics
NPI:1659924751
Name:SOUTHEASTERN BEHAVIORAL HEALTH AND CONSULTING
Entity Type:Organization
Organization Name:SOUTHEASTERN BEHAVIORAL HEALTH AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-516-1996
Mailing Address - Street 1:2997 COBB PKWY SE UNIT 725575
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-2703
Mailing Address - Country:US
Mailing Address - Phone:404-516-1996
Mailing Address - Fax:
Practice Address - Street 1:53 POPLAR ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1039
Practice Address - Country:US
Practice Address - Phone:404-516-1996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty