Provider Demographics
NPI:1639693047
Name:TRANSFORMATIONS THERAPY OF ATLANTA, LLC
Entity Type:Organization
Organization Name:TRANSFORMATIONS THERAPY OF ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-217-7563
Mailing Address - Street 1:4566 LAWRENCEVILLE HWY NW STE 101
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3686
Mailing Address - Country:US
Mailing Address - Phone:770-217-7563
Mailing Address - Fax:770-818-5253
Practice Address - Street 1:4566 LAWRENCEVILLE HWY NW STE 101
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3686
Practice Address - Country:US
Practice Address - Phone:770-217-7563
Practice Address - Fax:770-818-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004791101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty