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General NPI Number Information
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NPI Number | 1639028558
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Entity Type | Organization
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Legal Business Name | BLACK THERAPY COLLECTIVE LLC
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Dates
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Enumeration Date | 01/23/2026
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 2101 BONNIE PL
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City | AUGUSTA
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State | GA
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Zip | 30906-5021
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Country | US
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Telephone | 706-447-9623
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Fax |
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Provider Business Mailing Address
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Address Line | 246 ROBERT C DANIEL JR PKWY # 1127
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City | AUGUSTA
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State | GA
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Zip | 30909-0803
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Country | US
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Telephone | 706-447-9623
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Fax |
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Authorized Official
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Title or Position | OWNER / MANAGING MEMBER
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Name | CAPUS PATTON BARNETT
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Credential |
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Telephone | 706-447-9623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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