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General NPI Number Information
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NPI Number | 1629434758
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Entity Type | Organization
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Legal Business Name | ORION PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 317 W HILL ST
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City | DECATUR
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State | GA
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Zip | 30030-4367
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Country | US
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Telephone | 404-500-6102
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Fax |
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Provider Business Mailing Address
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Address Line | 988 WOODBOURNE DR SW
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City | ATLANTA
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State | GA
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Zip | 30310-4606
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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 | PSYCHOTHERAPIST
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Name | BRYAN CASEY CROOK
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Credential | M.A. LPC
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Telephone | 404-500-6102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | LPC008576
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License Number State | GA
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