Provider Demographics
NPI:1669678413
Name:SACRED MOUNTAIN PARTNERS, LLC
Entity Type:Organization
Organization Name:SACRED MOUNTAIN PARTNERS, LLC
Other - Org Name:FIRST MOUNTAIN COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-692-0131
Mailing Address - Street 1:340 PINE CREST RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-2662
Mailing Address - Country:US
Mailing Address - Phone:404-808-7740
Mailing Address - Fax:
Practice Address - Street 1:340 PINE CREST RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-2662
Practice Address - Country:US
Practice Address - Phone:404-808-7740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty