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General NPI Number Information
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NPI Number | 1912181082
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Entity Type | Organization
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Legal Business Name | OHM PSYCOTHERAPY INC
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 12/24/2007
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Provider Practice Location Address
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Address Line | 3594 OLD CHAMBLEE TUCKER RD
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City | ATLANTA
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State | GA
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Zip | 30341
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Country | US
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Telephone | 770-375-0479
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Fax | 678-985-4228
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Provider Business Mailing Address
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Address Line | 1083 SIMONTON HILL CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045
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Country | US
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Telephone | 770-375-0479
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Fax | 678-985-4228
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Authorized Official
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Title or Position | LIC CLINICAL SOCIAL WRKR THERAPIST
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Name | MS. OPAL H MINOTT
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Credential | LCSW
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Telephone | 770-375-0479
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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 | R0441101
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003893
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License Number State | GA
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