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General NPI Number Information
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NPI Number | 1528925138
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Entity Type | Organization
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Legal Business Name | THERAPYVINE
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 54 SONSHINE LN
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City | CHICKAMAUGA
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State | GA
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Zip | 30707-3679
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Country | US
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Telephone | 770-648-4911
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 105
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City | CHICKAMAUGA
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State | GA
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Zip | 30707-0105
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Country | US
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Telephone | 770-648-4911
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL DIRECTOR
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Name | DR. DANIEL KEITH GANN
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Credential | DMIN,MACMHC,LPC,NCC
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Telephone | 770-648-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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