Provider Demographics
NPI:1568997294
Name:UNIFY THERAPEUTICS & TRAINING CENTER LLC
Entity Type:Organization
Organization Name:UNIFY THERAPEUTICS & TRAINING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-944-9340
Mailing Address - Street 1:100 HARTSFIELD CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1341
Mailing Address - Country:US
Mailing Address - Phone:404-944-9340
Mailing Address - Fax:
Practice Address - Street 1:3900 CROWN RD SW
Practice Address - Street 2:SUITE 162251
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30304-0001
Practice Address - Country:US
Practice Address - Phone:404-944-9340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty