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General NPI Number Information
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NPI Number | 1942743687
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Entity Type | Organization
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Legal Business Name | 3D PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 1 W COURT SQ SUITE 750
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City | DECATUR
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State | GA
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Zip | 30030-2538
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Country | US
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Telephone | 404-620-6791
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Fax | 404-494-7701
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Provider Business Mailing Address
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Address Line | 1 W COURT SQ SUITE 750
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City | DECATUR
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State | GA
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Zip | 30030-2538
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Country | US
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Telephone | 404-620-6791
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Fax | 404-494-7701
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | DR. DEBRA DANTZLER
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Credential | PHD, LPC, MAC, NCC
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Telephone | 404-620-6791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 005479
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License Number State | GA
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