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General NPI Number Information
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NPI Number | 1376255448
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Entity Type | Organization
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Legal Business Name | WEEPING WILLOW THERAPY GROUP LLC
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Dates
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Enumeration Date | 12/20/2022
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 1970 MAIN ST E STE B53
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City | SNELLVILLE
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State | GA
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Zip | 30078-6463
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Country | US
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Telephone | 404-513-8839
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Fax |
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Provider Business Mailing Address
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Address Line | 1970 MAIN ST E STE B53
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City | SNELLVILLE
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State | GA
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Zip | 30078-6463
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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 | ADMINISTRATOR
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Name | BRANDON DAVIS
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Credential |
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Telephone | 404-513-8839
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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 |
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