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General NPI Number Information
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NPI Number | 1952946899
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Entity Type | Organization
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Legal Business Name | SWEETGRASS INTEGRATIVE COUNSELING AND THERAPY
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 2751 BUFORD HWY NE STE 402
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City | ATLANTA
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State | GA
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Zip | 30324-5456
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Country | US
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Telephone | 678-826-2801
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Fax |
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Provider Business Mailing Address
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Address Line | 2751 BUFORD HWY NE STE 402
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City | ATLANTA
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State | GA
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Zip | 30324-5456
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Country | US
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Telephone | 678-826-2801
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | LAURA J SILVERMAN
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Credential | LCSW
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Telephone | 678-826-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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