Healthcare Provider Details

I. General information

NPI: 1801694005
Provider Name (Legal Business Name): A. NORIEGA'S THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 LONG LEAF PINE DR
MIDLAND GA
31820-6321
US

IV. Provider business mailing address

9900 LONG LEAF PINE DR
MIDLAND GA
31820-6321
US

V. Phone/Fax

Practice location:
  • Phone: 706-426-3500
  • Fax:
Mailing address:
  • Phone: 706-426-3500
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: APRIL NORIEGA
Title or Position: LPC
Credential: MS
Phone: 706-426-3500