Provider Demographics
NPI:1134661945
Name:THERAPEUTIC IMPRESSIONS LLC
Entity Type:Organization
Organization Name:THERAPEUTIC IMPRESSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-595-2020
Mailing Address - Street 1:104 PILGRIM VILLAGE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9232
Mailing Address - Country:US
Mailing Address - Phone:678-595-2020
Mailing Address - Fax:
Practice Address - Street 1:104 PILGRIM VILLAGE DR STE 300
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9232
Practice Address - Country:US
Practice Address - Phone:678-595-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0057771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty