Healthcare Provider Details

I. General information

NPI: 1831521533
Provider Name (Legal Business Name): INNOVATIVE OPTIONS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 05/28/2023
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 CASCADE RD SW STE T-138
ATLANTA GA
30331-2009
US

IV. Provider business mailing address

3915 CASCADE RD SW STE T-138
ATLANTA GA
30331-2009
US

V. Phone/Fax

Practice location:
  • Phone: 844-580-5678
  • Fax: 678-288-7832
Mailing address:
  • Phone: 404-692-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTOINETTE NUMITAL THORNTON
Title or Position: CHIEF EXECTIVE OFFICER
Credential: LCSW
Phone: 757-580-5678