Provider Demographics
NPI:1578832143
Name:PSYCHOTHERAPY AND TRAUMA SPECIALISTS
Entity Type:Organization
Organization Name:PSYCHOTHERAPY AND TRAUMA SPECIALISTS
Other - Org Name:AMERICAN VETERANS PTSD TREATMENT CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BREHM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-719-8858
Mailing Address - Street 1:500 LANIER AVE W
Mailing Address - Street 2:SUITE 913
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7636
Mailing Address - Country:US
Mailing Address - Phone:770-719-8858
Mailing Address - Fax:770-719-8856
Practice Address - Street 1:500 LANIER AVE W
Practice Address - Street 2:SUITE 913
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7636
Practice Address - Country:US
Practice Address - Phone:770-719-8858
Practice Address - Fax:770-719-8856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004328251S00000X
GALPC006470251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health