Healthcare Provider Details

I. General information

NPI: 1700289063
Provider Name (Legal Business Name): ATLANTA RELATIONSHIP INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 NORTHRIDGE RD SUITE 310
ATLANTA GA
30350-3207
US

IV. Provider business mailing address

365 NORTHRIDGE RD SUITE 310
ATLANTA GA
30350-3207
US

V. Phone/Fax

Practice location:
  • Phone: 770-771-6903
  • Fax:
Mailing address:
  • Phone: 770-771-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007904
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001334
License Number StateGA

VIII. Authorized Official

Name: MS. MARILYN WITBECK
Title or Position: CO-OWNER
Credential: LMFT, LPC
Phone: 404-713-8749