Provider Demographics
NPI:1104256437
Name:ATLANTA PSYCHOTERAPY AND CONSULTING, LLC
Entity type:Organization
Organization Name:ATLANTA PSYCHOTERAPY AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOARES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-633-6503
Mailing Address - Street 1:1386 MURRAYS LOCH PL NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-8284
Mailing Address - Country:US
Mailing Address - Phone:770-633-6503
Mailing Address - Fax:
Practice Address - Street 1:1647 LOWER ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-3336
Practice Address - Country:US
Practice Address - Phone:770-633-6503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007474251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health