Black Swan LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

BLACK SWAN LLC

Doing business as

LIV Recovery Center

Practice address

4625 Alexander Dr Ste 200
Alpharetta, GA 30022-3721

Phone

(404) 513-5640

NPI assigned

Mar 20, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Todd Wilson

Title

Ceo

Phone

(404) 513-5640

Specialties & licenses 2

Addresses

Other names 1

• LIV Recovery Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764547200000",
    "number": "1679275846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4625 ALEXANDER DR STE 200",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300223721",
            "telephone_number": "404-513-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4625 ALEXANDER DR STE 200",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300223721",
            "telephone_number": "404-513-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK SWAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-20",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-513-5640"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIV Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LIV Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebecca Birch, BCBA
• Claire Birckhead
• Kelly Birdwell, PHARM D
• Yemisrach Mamo Bishaw, CSA,LSA
• Alison J Bishop, PT
• Amber Black, LPC
• Karen K Blackburn, PT, DPT
• Mary Rebecca Blackington, MD
• Marlene Louise Blaise, MD
• Heather Blakeslee

• Adult Mental Health Clinic/Center in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Adult Mental Health Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.