Provider Demographics
NPI:1528489473
Name:TRANSFORMATION THERAPY SERVICES, INC
Entity type:Organization
Organization Name:TRANSFORMATION THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-317-0430
Mailing Address - Street 1:5109 HIGHWAY 278 NE STE D
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2608
Mailing Address - Country:US
Mailing Address - Phone:770-787-2301
Mailing Address - Fax:770-787-9460
Practice Address - Street 1:5109 HIGHWAY 278 NE STE D
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2608
Practice Address - Country:US
Practice Address - Phone:770-787-2301
Practice Address - Fax:770-787-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005742251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107063AMedicaid