Provider Demographics
NPI:1770618092
Name:BEHAVIORAL HEALTH WELLNESS CENTER INC
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-548-0557
Mailing Address - Street 1:4706 JAMERSON FOREST CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066
Mailing Address - Country:US
Mailing Address - Phone:678-548-0557
Mailing Address - Fax:770-926-6184
Practice Address - Street 1:2470 WINDY HILL ROAD
Practice Address - Street 2:SUITE 366C
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:678-548-0557
Practice Address - Fax:770-926-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALMSW1840104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty