Healthcare Provider Details

I. General information

NPI: 1013360379
Provider Name (Legal Business Name): ORGANIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5283 BELLS FERRY RD STE120
ACWORTH GA
30102-2500
US

IV. Provider business mailing address

3450 JONES MILL ROAD 315
NORCROSS GA
30092
US

V. Phone/Fax

Practice location:
  • Phone: 678-923-0740
  • Fax: 770-393-6439
Mailing address:
  • Phone: 678-923-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name: MISS PATRICIA CHRISTINA THOMPSON
Title or Position: COUNSELOR
Credential: MACC
Phone: 678-923-0740