Healthcare Provider Details

I. General information

NPI: 1457189417
Provider Name (Legal Business Name): THERAPY HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 PEACHTREE PARK DR NE STE 102
ATLANTA GA
30309-1318
US

IV. Provider business mailing address

67 PEACHTREE PARK DR NE STE 102
ATLANTA GA
30309-1318
US

V. Phone/Fax

Practice location:
  • Phone: 404-436-2036
  • Fax:
Mailing address:
  • Phone: 404-436-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ERIN M RUPPEL
Title or Position: CO-OWNER
Credential: LPC
Phone: 678-858-4308