Organization
BEHAVIORAL HEALTH ASSOICATES OF GEORGIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FELICE MARTIN LPC (CEO)
(770) 376-7635
Entity
Organization
Contact information
Practice address
320 LANIER AVE W, FAYETTEVILLE, GA 30214-1600
(770) 376-7635
(678) 302-0810
Mailing address
320 LANIER AVE W, FAYETTEVILLE, GA 30214-1600
(770) 376-7635
(678) 302-0810
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC009575
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477912111
INDIVIDUAL NPI
—
Enumeration date
01/24/2018
Last updated
01/24/2018
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