Provider Demographics
NPI:1750446134
Name:NORTH FULTON PSYCHOTHERAPY ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:NORTH FULTON PSYCHOTHERAPY ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOCKS
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LCSW
Authorized Official - Phone:678-575-4444
Mailing Address - Street 1:120 PROSPECT PL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5445
Mailing Address - Country:US
Mailing Address - Phone:678-575-4444
Mailing Address - Fax:770-442-1919
Practice Address - Street 1:120 PROSPECT PL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5445
Practice Address - Country:US
Practice Address - Phone:678-575-4444
Practice Address - Fax:770-442-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCSW1220104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty