Provider Demographics
NPI:1245776665
Name:PROVIDENCE PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:PROVIDENCE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:478-396-8388
Mailing Address - Street 1:304 CHESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-1158
Mailing Address - Country:US
Mailing Address - Phone:478-396-8388
Mailing Address - Fax:478-971-4567
Practice Address - Street 1:304 CHESHIRE DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-1158
Practice Address - Country:US
Practice Address - Phone:478-396-8388
Practice Address - Fax:478-971-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT1001494251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health