BLACK SWAN LLC
NPI 1679275846
Clinic/Center - Adult Mental Health in Alpharetta, GA

NPI Status: Active since March 20, 2023

Contact Information

4625 ALEXANDER DR STE 200
ALPHARETTA, GA
ZIP 30022
Phone: (404) 513-5640

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  • Organization
  • Clinic/Center
  • Adult Mental Health
  • CLIA Number: 11D2273257
  • CLIA Cert. Type: Comp. Outpatient Rehab Facility
  • CLIA Exp. Date: 12-08-2026

About BLACK SWAN LLC

This page provides the complete NPI Profile along with additional information for Black Swan Llc, a provider established in Alpharetta, Georgia operating as a Clinic/center, focusing in adult mental health . The healthcare provider is registered in the NPI registry with number 1679275846 assigned on March 2023. The practitioner's primary taxonomy code is 261QM0850X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's . The authorized official of this NPI record is Todd Wilson (Ceo)

NPI
1679275846
Provider Legal Name
BLACK SWAN LLC
Other Organization Name
Other Name Type
(6)
Entity Type
Organization
Location Address
4625 ALEXANDER DR STE 200 ALPHARETTA, GA 30022
Location Phone
(404) 513-5640
Mailing Address
4625 ALEXANDER DR STE 200 ALPHARETTA, GA 30022
Mailing Phone
(404) 513-5640
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
03-20-2023
Last Update Date
12-01-2025
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center Adult Mental Health

Taxonomy Code
261QM0850X
Type
Ambulatory Health Care Facilities
Taxonomy Description
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1261QR0405XAmbulatory Health Care Facilities

Clinic/Center
Rehabilitation, Substance Use Disorder

 

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

TODD WILSON

Authorized Official Title
CEO
Authorized Official Phone
(404) 513-5640

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
11D2273257
Facility Type
Comp. Outpatient Rehab Facility
Certificate Effective Date
December 09, 2024
Certificate Expiration Date
December 08, 2026
Laboratory Director
TODD WILSON
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Black Swan Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1679275846, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 74. The final step is to find the difference between that total and the next multiple of ten (80 - 74 = 6).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1
1
Doubled → 2
Pos 2
6
Unchanged
Pos 3
7
Doubled → 14 → 1 + 4
Pos 4
9
Unchanged
Pos 5
2
Doubled → 4
Pos 6
7
Unchanged
Pos 7
5
Doubled → 10 → 1 + 0
Pos 8
8
Unchanged
Pos 9
4
Doubled → 8
Check
6
Target digit
Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 7 → 14 → 5 2 → 4 5 → 10 → 1 4 → 8

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 6 + 1 + 4 + 9 + 4 + 7 + 1 + 0 + 8 + 8 + 24 = 74

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 74 is 80. The difference is the calculated check digit.

80 - 74 = 6
This NPI is valid
The calculated check digit is 6, which matches the last digit of 1679275846.

Other Providers at the Same Location


The following 2 providers are registered at the same or a nearby location.

Social Worker
4625 ALEXANDER DR STE 200
ALPHARETTA, GA 30022
Counselor (Mental Health)
4625 ALEXANDER DR STE 200
ALPHARETTA, GA 30022

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1679275846, enumerated as an "organization" on March 20, 2023.

The provider is located at 4625 ALEXANDER DR STE 200 ALPHARETTA, GA 30022 and the phone number is (404) 513-5640.

Clinic/Center with taxonomy code 261QM0850X and a focus in Adult Mental Health.