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General NPI Number Information
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NPI Number | 1154464006
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Entity Type | Organization
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Legal Business Name | FAMILY ART THERAPY CENTER
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 44 COTTONWOOD ST.
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City | CLAYTON
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State | GA
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Zip | 30525
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Country | US
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Telephone | 706-782-0717
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Fax | 706-782-5266
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Provider Business Mailing Address
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Address Line | 44 COTTONWOOD ST.
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City | CLAYTON
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State | GA
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Zip | 30525
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Country | US
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Telephone | 706-782-0717
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Fax | 706-782-5266
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CARMEN ROSE REDD
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Credential |
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Telephone | 706-782-0717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC4008
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License Number State | GA
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