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General NPI Number Information
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NPI Number | 1154200392
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Entity Type | Individual
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Provider Name | ADITI MITRA PHD, MA, MFT
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Gender | Female
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 500 SUGAR MILL RD STE 100A
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City | ATLANTA
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State | GA
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Zip | 30350-6438
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Country | US
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Telephone | 470-502-5955
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 767684
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City | ROSWELL
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State | GA
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Zip | 30076-7684
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Country | US
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Telephone | 405-612-3491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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