Healthcare Provider Details

I. General information

NPI: 1235693342
Provider Name (Legal Business Name): ANXIETY AND STRESS MANAGEMENT INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 POWERS FERRY RD BUILDING 9 SUITE 100
MARIETTA GA
30067-5491
US

IV. Provider business mailing address

1640 POWERS FERRY RD BUILDING 9 SUITE 100
MARIETTA GA
30067-5491
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-0080
  • Fax:
Mailing address:
  • Phone: 770-953-0080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY TAGTACHIAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 770-548-2589