Healthcare Provider Details

I. General information

NPI: 1366032542
Provider Name (Legal Business Name): MEREDITH LYNNE REPASKY AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEREDITH LYNNE RIDGELL

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 WHITLOCK AVE SW STE H10
MARIETTA GA
30064-3098
US

IV. Provider business mailing address

707 WHITLOCK AVE SW STE H10
MARIETTA GA
30064-3098
US

V. Phone/Fax

Practice location:
  • Phone: 770-759-0691
  • Fax:
Mailing address:
  • Phone: 770-759-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT121322
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT002081
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: