Provider Demographics
NPI:1366849010
Name:SENIOR THERAPY ASSOCIATES OF ATLANTA, INC
Entity Type:Organization
Organization Name:SENIOR THERAPY ASSOCIATES OF ATLANTA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-272-1451
Mailing Address - Street 1:4000 RIVERLOOK PKWY SE
Mailing Address - Street 2:UNIT 207
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4846
Mailing Address - Country:US
Mailing Address - Phone:404-272-1451
Mailing Address - Fax:
Practice Address - Street 1:4000 RIVERLOOK PKWY SE
Practice Address - Street 2:UNIT 207
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4846
Practice Address - Country:US
Practice Address - Phone:404-272-1451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW005154251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health