Provider Demographics
NPI:1972635407
Name:COGNITIVE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:COGNITIVE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LPC
Authorized Official - Phone:770-827-2262
Mailing Address - Street 1:3004 MILL GROVE TER
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:770-783-8927
Practice Address - Street 1:5415 THOMPSON MILL ROAD STE B
Practice Address - Street 2:DR DEVIN VICKNAIR
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548
Practice Address - Country:US
Practice Address - Phone:770-827-2262
Practice Address - Fax:770-783-8927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003253101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty