Provider Demographics
NPI:1114742939
Name:MASTER IT BEHAVIOR THERAPY OF GEORGIA
Entity type:Organization
Organization Name:MASTER IT BEHAVIOR THERAPY OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-223-1853
Mailing Address - Street 1:2 E BRYAN ST FL 4
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-2655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1870 THE EXCHANGE SE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2021
Practice Address - Country:US
Practice Address - Phone:833-653-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty