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General NPI Number Information
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NPI Number | 1013360379
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Entity Type | Organization
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Legal Business Name | ORGANIC THERAPY
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 5283 BELLS FERRY RD STE120
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City | ACWORTH
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State | GA
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Zip | 30102-2500
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Country | US
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Telephone | 678-923-0740
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Fax | 770-393-6439
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Provider Business Mailing Address
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Address Line | 3450 JONES MILL ROAD 315
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City | NORCROSS
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State | GA
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Zip | 30092
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Country | US
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Telephone | 678-923-0740
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MISS PATRICIA CHRISTINA THOMPSON
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Credential | MACC
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Telephone | 678-923-0740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | GA
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