Provider Demographics
NPI:1124451570
Name:COMMUNITY BEHAVIORAL CENTER LLC
Entity type:Organization
Organization Name:COMMUNITY BEHAVIORAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-996-4286
Mailing Address - Street 1:2245 GODBY RD
Mailing Address - Street 2:SUITE 102 & 104
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5059
Mailing Address - Country:US
Mailing Address - Phone:404-996-4286
Mailing Address - Fax:
Practice Address - Street 1:2245 GODBY RD
Practice Address - Street 2:SUITE 102 & 104
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5059
Practice Address - Country:US
Practice Address - Phone:404-996-4286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007314251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health