Provider Demographics
NPI:1659695286
Name:THERAPEUTIC CONNECTIONS
Entity Type:Organization
Organization Name:THERAPEUTIC CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATIYA
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:OSHODI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-542-7690
Mailing Address - Street 1:119 AUTUMN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-7186
Mailing Address - Country:US
Mailing Address - Phone:678-542-7690
Mailing Address - Fax:
Practice Address - Street 1:119 AUTUMN CREEK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-7186
Practice Address - Country:US
Practice Address - Phone:678-542-7690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0033791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty