Provider Demographics
NPI:1790301091
Name:TRI-STATE BEHAVIORAL HEALTH, INC
Entity Type:Organization
Organization Name:TRI-STATE BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-447-9241
Mailing Address - Street 1:2774 COBB PKWY NW STE 109-140
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3469
Mailing Address - Country:US
Mailing Address - Phone:404-447-9241
Mailing Address - Fax:
Practice Address - Street 1:1350 WOOTEN LAKE RD NW STE 210
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1348
Practice Address - Country:US
Practice Address - Phone:404-447-9241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health