Provider Demographics
NPI:1851607923
Name:TODD, KATRINA (MA,LAMFT,BCBA,MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:MA,LAMFT,BCBA,MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 170062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-0062
Mailing Address - Country:US
Mailing Address - Phone:678-626-0557
Mailing Address - Fax:
Practice Address - Street 1:3760 LAVISTA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5615
Practice Address - Country:US
Practice Address - Phone:678-626-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-10491103K00000X
GAAMFT000418106H00000X
GAMUT000049225A00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
47-1150273OtherEIN