Provider Demographics
NPI:1760004758
Name:CIRCLE OF THERAPEUTIC ALLIANCE AND CONSULTING, LLC
Entity Type:Organization
Organization Name:CIRCLE OF THERAPEUTIC ALLIANCE AND CONSULTING, LLC
Other - Org Name:2THEDEGREE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DEL
Authorized Official - Phone:470-206-1260
Mailing Address - Street 1:159 BURKE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3428
Mailing Address - Country:US
Mailing Address - Phone:470-206-1262
Mailing Address - Fax:404-738-2932
Practice Address - Street 1:159 BURKE ST STE 250
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3430
Practice Address - Country:US
Practice Address - Phone:470-206-1260
Practice Address - Fax:678-550-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003234513AMedicaid