Provider Demographics
NPI:1013360379
Name:ORGANIC THERAPY
Entity Type:Organization
Organization Name:ORGANIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MACC
Authorized Official - Phone:678-923-0740
Mailing Address - Street 1:3450 JONES MILL ROAD
Mailing Address - Street 2:315
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092
Mailing Address - Country:US
Mailing Address - Phone:678-923-0740
Mailing Address - Fax:
Practice Address - Street 1:5283 BELLS FERRY RD
Practice Address - Street 2:STE120
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-2500
Practice Address - Country:US
Practice Address - Phone:678-923-0740
Practice Address - Fax:770-393-6439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty