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General NPI Number Information
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NPI Number | 1821348004
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Entity Type | Organization
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Legal Business Name | ANSLEY PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 1904 MONROE DR NE SUITE 120
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City | ATLANTA
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State | GA
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Zip | 30324-4858
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Country | US
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Telephone | 404-323-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 1904 MONROE DR NE SUITE 120
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City | ATLANTA
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State | GA
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Zip | 30324-4858
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Country | US
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Telephone | 404-323-6080
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | F. CATHARINE WIRTH
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Credential | LCSW, MA
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Telephone | 404-323-6080
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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 | CSW004739
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License Number State | GA
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