Basic Information
| Provider Information | |||||||||
| NPI: | 1750947255 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTA THERAPY AND WELLNESS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 CHURCH ST STE 109 | ||||||||
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| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300303330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064610919 | ||||||||
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| Address1: | 215 CHURCH ST STE 109 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300303330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048529982 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2019 | ||||||||
| LastUpdateDate: | 06/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | BRITNI | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7064610919 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.