Moon River, Llc is a Psychology Clinic in Marietta, Georgia. It is located at 790 Oak Trail Dr, Marietta, GA and its contact number is 770-977-6866. The authorized person for Moon River, Llc is Laura Desantis
who is Office Manager of the clinic and his/her contact number is 770-212-2170.
Moon River, Llc Clinic specialize in psychological testing and evaluating or assessing patient's personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning. Accordingly, psychologists performs counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy. Psychologists can diagnose and treat mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability by psycheducational evaluation, therapy, remediation, and consultation.
Complete Clinic Profile:
Moon River, Llc Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
| Name: | Moon River, Llc |
| Specialization: | General Psychology |
| Clinic Address: | 790 Oak Trail Dr, Marietta,
Georgia, 30062-7502 |
| Phone: | 770-977-6866 |
| Fax: | 770-977-6887 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
| Name: | Laura Desantis |
| Position: | Office Manager |
| Contact Number: | 770-212-2170 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for Moon River, Llc clinic are as mentioned below.
| NPI Number: | 1730143553 |
| NPI Enumeration Date: | 17 Apr, 2006 |
| NPI Last Update On: | 18 Feb, 2025 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Moon River, Llc are as mentioned below.
| Specialization | License Number | State | Status | |
| Behavioral Analyst | | | Primary | |
| Psychologist | | | Secondary | |
| Physical Therapist | PT003833 | Georgia | Secondary | |
| Pediatrics | OT 004293 | Georgia | Secondary | |
| Pediatrics | GAOT001717 | Georgia | Secondary | |
| Speech-language Pathologist | SLP003992 | Georgia | Secondary | |
| Speech-language Pathologist | SLP005806 | Georgia | Secondary | |
| Speech-language Pathologist | SLP006528 | Georgia | Secondary | |
| Speech-language Pathologist | SLP 06551 | Georgia | Secondary | |
| Speech-language Pathologist | SLP 006556 | Georgia | Secondary | |
Other Medical Identifiers:
Other legacy medical identifiers of the clinic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 000970835A | Medicaid | Georgia | |
| 317872221A | Medicaid | Georgia | |
| 503885675B | Medicaid | Georgia | |
| 315889908A | Medicaid | Georgia | |
| 339518223A | Medicaid | Georgia | |
| 516643175A | Medicaid | Georgia | |
| 761415888A | Medicaid | Georgia | |
| 765677599A | Medicaid | Georgia | |
| 814363142A | Medicaid | Georgia | |
| 188883028B | Medicaid | Georgia | |
| 426315361A | Medicaid | Georgia | |
| 000753563E | Medicaid | Georgia | |
| 191707573A | Medicaid | Georgia | |
| 461168837A | Medicaid | Georgia | |
| 481436178B | Medicaid | Georgia | |
| 000860736B | Medicaid | Georgia | |
| 240960806A | Medicaid | Georgia | |
| 850524466A | Medicaid | Georgia | |
| 146855825A | Medicaid | Georgia | |
| 986209149B | Medicaid | Georgia | |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Moon River, Llc
790 Oak Trail Dr,
Marietta, Georgia |
| Zip: | 30062-7502 |
| Phone Number: | 770-212-2170 |
| Fax Number: | 770-783-8639 |
Patients can reach Moon River, Llc at
790 Oak Trail Dr, Marietta, Georgia or can
call to book an appointment on 770-977-6866.
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Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 December, 2025.