Provider Demographics
NPI:1376200048
Name:COLLECTIVE THERAPY LLC
Entity Type:Organization
Organization Name:COLLECTIVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:MCDONALD
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:478-595-0317
Mailing Address - Street 1:2035 REBIE RD
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31022-2411
Mailing Address - Country:US
Mailing Address - Phone:478-595-0317
Mailing Address - Fax:888-249-2172
Practice Address - Street 1:121 W JACKSON ST STE 104
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6169
Practice Address - Country:US
Practice Address - Phone:478-595-0317
Practice Address - Fax:888-249-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty