Provider Demographics
NPI:1568837391
Name:RIVER PSYCHOTHERAPY ASSOCIATES
Entity type:Organization
Organization Name:RIVER PSYCHOTHERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:706-322-3280
Mailing Address - Street 1:2570 BROOKSTONE CENTRE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4670
Mailing Address - Country:US
Mailing Address - Phone:706-322-3280
Mailing Address - Fax:706-322-2272
Practice Address - Street 1:2570 BROOKSTONE CENTRE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4670
Practice Address - Country:US
Practice Address - Phone:706-322-3280
Practice Address - Fax:706-322-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1275680274OtherNPI