Healthcare Provider Details

I. General information

NPI: 1922642644
Provider Name (Legal Business Name): THERAPEUTIC ALLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 HILLCREST RD NW STE 400
LILBURN GA
30047-6896
US

IV. Provider business mailing address

4221 GRAVITT PL
DULUTH GA
30096-4385
US

V. Phone/Fax

Practice location:
  • Phone: 404-955-3306
  • Fax:
Mailing address:
  • Phone: 404-955-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALFREDO MORALES CELEDON
Title or Position: REGISTER AGENT
Credential: LPC, NCC
Phone: 404-955-3306