MEDICARE: MIDDLE PATH THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	7784	GA
2	101YM0800X	Mental Health Counselor	7465	GA

General Provider Information

NPI Number	:	1073014734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLE PATH THERAPY, LLC

Provider Business Mailing Address
First Line	:	209B SWANTON WAY STE 204
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-3271
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 BUFORD HWY NE STE 470
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30329-2124
Country	:	US
Telephone Number	:	404-354-4026
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	ERIN HINEK
Credential	:	LPC
Telephone Number	:	404-354-4026

Provider Enumeration Date	:	02/27/2018
Last Update Date	:	06/05/2020

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