Healthcare Provider Details

I. General information

NPI: 1760386924
Provider Name (Legal Business Name): SVETLANA TITKOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 N RAMPART ST
CANTON GA
30114-1301
US

IV. Provider business mailing address

312 N RAMPART ST
CANTON GA
30114-1301
US

V. Phone/Fax

Practice location:
  • Phone: 470-560-8700
  • Fax:
Mailing address:
  • Phone: 470-560-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: