Provider Demographics
NPI:1881080117
Name:ATLANTA BEHAVIORAL & MENTAL HEALTH COUNSELING, LLC
Entity type:Organization
Organization Name:ATLANTA BEHAVIORAL & MENTAL HEALTH COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:770-778-6997
Mailing Address - Street 1:59 ANDERSON AVENUE
Mailing Address - Street 2:# 308
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114
Mailing Address - Country:US
Mailing Address - Phone:770-778-6997
Mailing Address - Fax:
Practice Address - Street 1:59 ANDERSON AVE
Practice Address - Street 2:#308
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2328
Practice Address - Country:US
Practice Address - Phone:770-778-6997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0065801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty