Healthcare Provider Details

I. General information

NPI: 1629544341
Provider Name (Legal Business Name): RESILIENT FOCUSED FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2018
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5534 OLD NATIONAL HWY STE 150
COLLEGE PARK GA
30349-3274
US

IV. Provider business mailing address

5534 OLD NATIONAL HWY STE 150
COLLEGE PARK GA
30349-3274
US

V. Phone/Fax

Practice location:
  • Phone: 470-334-8917
  • Fax: 404-529-4473
Mailing address:
  • Phone: 470-334-8917
  • Fax: 404-529-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TANYA RENEE SYKES-CLARK
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 404-421-2896