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General NPI Number Information
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NPI Number | 1861851792
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Entity Type | Organization
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Legal Business Name | CACAO,LLC
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Dates
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Enumeration Date | 02/20/2016
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Last Update Date | 02/20/2016
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Provider Practice Location Address
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Address Line | 1820 PEACHTREE ST NW UNIT 1607
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City | ATLANTA
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State | GA
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Zip | 30309-8403
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Country | US
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Telephone | 770-468-3766
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 PEACHTREE ST NW UNIT 1607
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City | ATLANTA
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State | GA
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Zip | 30309-8403
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Country | US
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Telephone | 770-468-3766
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LORI ANN WHATLEY
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Credential | LMFT
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Telephone | 770-468-3766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000315
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License Number State | GA
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