Provider Demographics
NPI:1225420177
Name:REALISTIC TRANSFORMATIONS, LLC
Entity Type:Organization
Organization Name:REALISTIC TRANSFORMATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:GREER
Authorized Official - Last Name:WHARTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:251-377-9400
Mailing Address - Street 1:171 COMMERCE DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2169
Mailing Address - Country:US
Mailing Address - Phone:251-377-9400
Mailing Address - Fax:
Practice Address - Street 1:171 COMMERCE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2169
Practice Address - Country:US
Practice Address - Phone:251-377-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health