Provider Demographics
NPI:1518237361
Name:ATLANTA COMPREHENSIVE THERAPY, LLC
Entity Type:Organization
Organization Name:ATLANTA COMPREHENSIVE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:ALLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST.LIFER KOORIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-925-3516
Mailing Address - Street 1:3003 BYRONS POND DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8330
Mailing Address - Country:US
Mailing Address - Phone:678-925-3516
Mailing Address - Fax:678-401-6171
Practice Address - Street 1:1640 POWERS FERRY RD
Practice Address - Street 2:BUILDING 3, SUITE 250
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:678-925-3516
Practice Address - Fax:678-401-6171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 1041C0700X, 106H00000X
GACSW0038451041C0700X
MA10217091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty