Provider Demographics
NPI:1679916316
Name:INNOVATIVE OPTIONS INCORPORATED
Entity Type:Organization
Organization Name:INNOVATIVE OPTIONS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:NUMITAL
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CSAC, CSOTP
Authorized Official - Phone:757-237-8460
Mailing Address - Street 1:2016 SANDTOWN RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-3420
Mailing Address - Country:US
Mailing Address - Phone:757-237-8460
Mailing Address - Fax:
Practice Address - Street 1:2016 SANDTOWN RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-3420
Practice Address - Country:US
Practice Address - Phone:757-237-8460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty