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NPI Code Detail

MEDICARE: THERAPEUTIC IMPRESSIONS LLC

MEDICARE: THERAPEUTIC IMPRESSIONS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker005777GA

General Provider Information

NPI Number : 1134661945
Entity Type Code : Organization
Provider Name (Legal Business Name) : THERAPEUTIC IMPRESSIONS LLC
Provider Business Mailing Address
First Line : 104 PILGRIM VILLAGE DR STE 300
Second Line :
City : CUMMING
State : GA
Zip : 30040-9232
Country : US
Telephone Number : 678-595-2020
Fax Number :
Provider Business Practice Location Address
First Line : 104 PILGRIM VILLAGE DR STE 300
Second Line :
City : CUMMING
State : GA
Zip : 30040-9232
Country : US
Telephone Number : 678-595-2020
Fax Number :
Authorized Official
Title or Position : OWNER, THERAPIST
Name : JESSICA B SHERIDAN
Credential : LCSW
Telephone Number : 678-595-2020
Provider Enumeration Date : 11/09/2016
Last Update Date : 11/09/2016

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Directions to “THERAPEUTIC IMPRESSIONS LLC ” Practice Location

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