Georgia Adolescent Program LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

GEORGIA ADOLESCENT PROGRAM LLC

Practice address

2255 Sewell Rd Ste 130
Marietta, GA 30062

Phone

(781) 472-0247

NPI assigned

Oct 16, 2026

Last updated

Oct 16, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Matthew Dinicola

Title

Owner

Phone

(781) 472-0247

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1792108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792108800000",
    "number": "1881590784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 SEWELL MILL RD STE 130",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300627218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 SEWELL RD STE 130",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30062",
            "telephone_number": "781-472-0247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA ADOLESCENT PROGRAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-16",
        "last_updated": "2026-10-16",
        "certification_date": "2026-10-14",
        "status": "A",
        "authorized_official_last_name": "DINICOLA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-472-0247"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stanley Ray Gentry
• Christinia George, RPH, BCGP
• Monifa George
• Sonia Valita George, M.D.
• Suku George, MD., MPH.
• Georgia Anesthesia Providers LLC
• Georgia Balance Tesing PC
• Georgia Cancer Specialists I PC
• Georgia CVS Pharmacy LLC (CVS Pharmacy #17204)
• Georgia CVS Pharmacy LLC (CVS Pharmacy #16526)

• Mental Health Clinic/Center (Including Community Mental Health Center) in Marietta, GA
• Providers in Marietta, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.