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General NPI Number Information
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NPI Number | 1922642644
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC ALLIES
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Dates
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Enumeration Date | 11/06/2019
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 540 POWDER SPRINGS ST STE C17
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City | MARIETTA
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State | GA
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Zip | 30064-3561
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Country | US
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Telephone | 404-642-8381
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Fax |
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Provider Business Mailing Address
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Address Line | 4221 GRAVITT PL
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City | DULUTH
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State | GA
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Zip | 30096-4385
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Country | US
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Telephone | 404-955-3306
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Fax |
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Authorized Official
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Title or Position | REGISTER AGENT
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Name | ALFREDO MORALES CELEDON
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Credential | LPC, NCC
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Telephone | 404-955-3306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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