Provider Demographics
NPI:1407582042
Name:GEORGIA CTC, LLC
Entity type:Organization
Organization Name:GEORGIA CTC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-716-9335
Mailing Address - Street 1:6183 PASEO DEL NORTE STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1151
Mailing Address - Country:US
Mailing Address - Phone:607-710-0819
Mailing Address - Fax:
Practice Address - Street 1:311 WHITE INGRAM PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0969
Practice Address - Country:US
Practice Address - Phone:770-615-0951
Practice Address - Fax:678-363-7787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADIA HEALTHCARE COMPANY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-26
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder