Healthcare Provider Details

I. General information

NPI: 1972684736
Provider Name (Legal Business Name): MUSIC THERAPY SERVICES OF GREATER ATLANTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 BULLOCH AVENUE
ROSWELL GA
30075
US

IV. Provider business mailing address

114 BULLOCH AVENUE
ROSWELL GA
30075
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-6565
  • Fax: 678-277-2633
Mailing address:
  • Phone: 678-560-6565
  • Fax: 678-277-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH ANN HAMPSHIRE
Title or Position: OWNER DIRECTOR
Credential: NMT, MT-BC
Phone: 678-560-6560