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General NPI Number Information
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NPI Number | 1083156590
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Entity Type | Organization
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Legal Business Name | PEACHTREE ART THERAPY AND COUNSELING
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 1708 PEACHTREE ST NW 204
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City | ATLANTA
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State | GA
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Zip | 30309-2434
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Country | US
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Telephone | 678-222-2987
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Fax |
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Provider Business Mailing Address
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Address Line | 787 MARTINA DR NE
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City | ATLANTA
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State | GA
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Zip | 30305-2737
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | JEAN FRASER MILLS
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Credential | MA
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Telephone | 404-245-0627
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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 | 006281
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License Number State | GA
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