Provider Demographics
NPI:1164268595
Name:ROCKET CITY BEHAVIORAL HEALTH & BILLING, LLC
Entity type:Organization
Organization Name:ROCKET CITY BEHAVIORAL HEALTH & BILLING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLESS
Authorized Official - Suffix:
Authorized Official - Credentials:MS-SHMA, BSW
Authorized Official - Phone:256-585-4991
Mailing Address - Street 1:4095 LAWSON RIDGE DR APT 1308
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-7232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4095 LAWSON RIDGE DR APT 1308
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757-7232
Practice Address - Country:US
Practice Address - Phone:256-585-4991
Practice Address - Fax:256-314-9439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-04
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty