Provider Demographics
NPI:1215636295
Name:PRACTICAL CHILD THERAPY LLC
Entity type:Organization
Organization Name:PRACTICAL CHILD THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:SEMONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-951-4122
Mailing Address - Street 1:7033 GRAND HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-6253
Mailing Address - Country:US
Mailing Address - Phone:678-951-4122
Mailing Address - Fax:
Practice Address - Street 1:7033 GRAND HICKORY DR
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-6253
Practice Address - Country:US
Practice Address - Phone:678-951-4122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty