Healthcare Provider Details

I. General information

NPI: 1437886728
Provider Name (Legal Business Name): ENRICH THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 GLENWOOD AVE SE STE 510
ATLANTA GA
30316-2176
US

IV. Provider business mailing address

830 GLENWOOD AVE SE STE 510
ATLANTA GA
30316-2176
US

V. Phone/Fax

Practice location:
  • Phone: 470-377-1795
  • Fax:
Mailing address:
  • Phone: 470-377-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHANTELLE HARRISON
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 470-377-1795