Provider Demographics
NPI:1295531457
Name:WONDERLAND BEHAVIORAL & MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:WONDERLAND BEHAVIORAL & MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC, LMSW
Authorized Official - Phone:770-284-6472
Mailing Address - Street 1:100 N POINT CTR E STE 125
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8214
Mailing Address - Country:US
Mailing Address - Phone:770-284-6472
Mailing Address - Fax:877-862-0076
Practice Address - Street 1:100 N POINT CTR E STE 125
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8214
Practice Address - Country:US
Practice Address - Phone:770-284-6472
Practice Address - Fax:877-862-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty