Provider Demographics
NPI:1215447081
Name:TRANSFORMATIONS THERAPY OF ATLANTA, LLC
Entity type:Organization
Organization Name:TRANSFORMATIONS THERAPY OF ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-217-7563
Mailing Address - Street 1:4566 LAWRENCEVILLE HWY NW STE 101
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3686
Mailing Address - Country:US
Mailing Address - Phone:770-217-7563
Mailing Address - Fax:
Practice Address - Street 1:4566 LAWRENCEVILLE HWY NW STE 101
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3686
Practice Address - Country:US
Practice Address - Phone:770-217-7563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty