Healthcare Provider Details

I. General information

NPI: 1306985072
Provider Name (Legal Business Name): THERAPIST DIRECT INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 BENTLEY PLACE WAY
COVINGTON GA
30016-1106
US

IV. Provider business mailing address

260 BENTLEY PLACE WAY
COVINGTON GA
30016-1106
US

V. Phone/Fax

Practice location:
  • Phone: 404-756-2600
  • Fax: 404-756-2524
Mailing address:
  • Phone: 404-756-2600
  • Fax: 404-756-2524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA000040
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP004287
License Number StateGA

VIII. Authorized Official

Name: MRS. SABRENIA RENEE ROBERTS
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MA, CCC, SLP
Phone: 678-725-4628