Healthcare Provider Details

I. General information

NPI: 1619576865
Provider Name (Legal Business Name): THERAPY POND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 04/21/2025
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 LONE OAK ROAD
GRANTVILLE GA
30220
US

IV. Provider business mailing address

1911 ELLIS ROAD
HOGANSVILLE GA
30230
US

V. Phone/Fax

Practice location:
  • Phone: 678-653-3366
  • Fax:
Mailing address:
  • Phone: 678-653-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGIE UL HAMILTON
Title or Position: OWNER
Credential: LPC
Phone: 561-758-8268