Organization
LOUISE WISE LLC
Active
Other names
Georgia Behavioral Health Practitioner Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
LOUISE WISE (PROVIDER)
(678) 831-6429
Entity
Organization
Contact information
Practice address
2206 HANFRED LN STE 103, TUCKER, GA 30084-4809
(678) 831-6429
(687) 668-2848
Mailing address
PO BOX 309, CLARKSTON, GA 30021-0309
(678) 368-5561
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/26/2019
Last updated
04/09/2023
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