Healthcare Provider Details

I. General information

NPI: 1548228281
Provider Name (Legal Business Name): ATLANTA PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 COUNTRY CLUB DR SUITE 200-E
STOCKBRIDGE GA
30281-9054
US

IV. Provider business mailing address

175 COUNTRY CLUB DR SUITE 200-E
STOCKBRIDGE GA
30281-9054
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-1925
  • Fax: 770-389-3077
Mailing address:
  • Phone: 770-389-1925
  • Fax: 770-389-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCSW 002841
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSAP 10384
License Number StateGA

VIII. Authorized Official

Name: DOROTHY D WATTS
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 770-389-1925