Provider Demographics
NPI:1083156590
Name:PEACHTREE ART THERAPY AND COUNSELING
Entity Type:Organization
Organization Name:PEACHTREE ART THERAPY AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:FRASER
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:404-245-0627
Mailing Address - Street 1:787 MARTINA DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1708 PEACHTREE ST NW
Practice Address - Street 2:204
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2434
Practice Address - Country:US
Practice Address - Phone:678-222-2987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty