| Black Swan Llc | |
|
4625 Alexander Dr Ste 200 Alpharetta GA 30022-3721 | |
| (404) 513-5640 | |
| Not Available |
| Full Name | Black Swan Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 4625 Alexander Dr Ste 200, Alpharetta, Georgia |
| Authorized Official Name and Position | Todd Wilson (CEO) |
| Authorized Official Contact | 4045135640 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Swan Llc 4625 Alexander Dr Ste 200 Alpharetta GA 30022-3721 Ph: (404) 513-5640 | Black Swan Llc 4625 Alexander Dr Ste 200 Alpharetta GA 30022-3721 Ph: (404) 513-5640 |
| NPI Number | 1679275846 |
|---|---|
| Provider Enumeration Date | 03/20/2023 |
| Last Update Date | 12/01/2025 |
| Certification Date | 12/01/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679275846 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Secondary |
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