Provider Demographics
NPI:1356679625
Name:HEALING PSYCHOTHERAPY PRACTICES OF GEORGIA
Entity Type:Organization
Organization Name:HEALING PSYCHOTHERAPY PRACTICES OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-553-1291
Mailing Address - Street 1:2378 WHITES RDG
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1110
Mailing Address - Country:US
Mailing Address - Phone:404-553-1291
Mailing Address - Fax:
Practice Address - Street 1:125 TOWNPARK DR NW
Practice Address - Street 2:SUITE 300
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5803
Practice Address - Country:US
Practice Address - Phone:404-553-1291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty