Provider Demographics
NPI:1609129188
Name:SHANTI PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:SHANTI PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:II
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-640-1263
Mailing Address - Street 1:4307 SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-7617
Mailing Address - Country:US
Mailing Address - Phone:678-640-1263
Mailing Address - Fax:770-306-4638
Practice Address - Street 1:276 DECATUR ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1755
Practice Address - Country:US
Practice Address - Phone:678-640-1263
Practice Address - Fax:404-659-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-20
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004725251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health