Provider Demographics
NPI:1891143244
Name:CHOICES BEHAVIORAL ALTERNATIVES
Entity Type:Organization
Organization Name:CHOICES BEHAVIORAL ALTERNATIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,NCC,CSOTS,CAMS,C
Authorized Official - Phone:770-681-2303
Mailing Address - Street 1:1495 WATERCOVE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-7041
Mailing Address - Country:US
Mailing Address - Phone:770-681-2303
Mailing Address - Fax:
Practice Address - Street 1:4037 DARLING COURT
Practice Address - Street 2:SUITE B
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047
Practice Address - Country:US
Practice Address - Phone:770-681-2303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty