Provider Demographics
NPI: | 1437778354 |
---|---|
Name: | THERAPEUTIC ALLIANCE LLC |
Entity Type: | Organization |
Organization Name: | THERAPEUTIC ALLIANCE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/PSYCHOTHERAPIST |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | NICOLE |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | BUDDLE-DIAZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 678-699-6208 |
Mailing Address - Street 1: | 2300 LAKEVIEW PARKWAY |
Mailing Address - Street 2: | SUITE 700 |
Mailing Address - City: | ALPHARETTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30009 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 678-699-6208 |
Mailing Address - Fax: | 678-916-3810 |
Practice Address - Street 1: | 2300 LAKEVIEW PARKWAY |
Practice Address - Street 2: | SUITE 700 |
Practice Address - City: | ALPHARETTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30009 |
Practice Address - Country: | US |
Practice Address - Phone: | 678-699-6208 |
Practice Address - Fax: | 678-916-3810 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-04-10 |
Last Update Date: | 2020-05-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Single Specialty |