Provider Demographics
NPI:1538472980
Name:PEACHTREE PSYCHOTHERAPY
Entity Type:Organization
Organization Name:PEACHTREE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DINGLER
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:404-735-2399
Mailing Address - Street 1:111 PETROL PT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1550
Mailing Address - Country:US
Mailing Address - Phone:678-364-0135
Mailing Address - Fax:678-364-0136
Practice Address - Street 1:111 PETROL PT
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1550
Practice Address - Country:US
Practice Address - Phone:678-364-0135
Practice Address - Fax:678-364-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty