=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619576865
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPY POND, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2020
-----------------------------------------------------
Last Update Date | 04/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2939 LONE OAK ROAD
-----------------------------------------------------
City | GRANTVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-653-3366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1911 ELLIS ROAD
-----------------------------------------------------
City | HOGANSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-653-3366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ANGIE UL HAMILTON
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 561-758-8268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------