Provider Demographics
NPI:1720405376
Name:A WHITE THERAPY GROUP, LLC
Entity Type:Organization
Organization Name:A WHITE THERAPY GROUP, LLC
Other - Org Name:A W COUNSELING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:PROF
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-539-4110
Mailing Address - Street 1:3295 RIVER EXCHANGE DR STE 302
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4238
Mailing Address - Country:US
Mailing Address - Phone:404-539-4110
Mailing Address - Fax:
Practice Address - Street 1:3295 RIVER EXCHANGE DR STE 302
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-4238
Practice Address - Country:US
Practice Address - Phone:404-539-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty