Provider Demographics
NPI:1578227054
Name:THE COMPASSIONATE COUCH LLC
Entity Type:Organization
Organization Name:THE COMPASSIONATE COUCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-680-8858
Mailing Address - Street 1:11585 JONES BRIDGE RD STE 420
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7476
Mailing Address - Country:US
Mailing Address - Phone:678-680-8858
Mailing Address - Fax:
Practice Address - Street 1:3710 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1867
Practice Address - Country:US
Practice Address - Phone:678-680-8858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty