Provider Demographics
NPI:1437886728
Name:ENRICH THERAPY GROUP
Entity Type:Organization
Organization Name:ENRICH THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-903-1480
Mailing Address - Street 1:5284 FLOYD RD SW UNIT 233
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-6102
Mailing Address - Country:US
Mailing Address - Phone:252-903-1480
Mailing Address - Fax:
Practice Address - Street 1:275 VININGS RETREAT VW SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-2574
Practice Address - Country:US
Practice Address - Phone:252-903-1480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty