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General NPI Number Information
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NPI Number | 1114559549
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIVE THERAPY GROUP LLC
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 250 GEORGIA AVE SE STE 203
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City | ATLANTA
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State | GA
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Zip | 30312-3000
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Country | US
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Telephone | 470-377-5990
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Fax |
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Provider Business Mailing Address
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Address Line | 1702 BOULDER WALK LN SE
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City | ATLANTA
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State | GA
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Zip | 30316-3991
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Country | US
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Telephone | 770-789-5063
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHADONNA DAVIS
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Credential | PHD
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Telephone | 470-377-5990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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