Provider Demographics
NPI:1881043420
Name:CORE THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CORE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:LAMFT, BCBA, MT-BC
Authorized Official - Phone:678-626-0557
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:678-288-7932
Practice Address - Street 1:3760 LAVISTA RD STE 102
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5622
Practice Address - Country:US
Practice Address - Phone:678-626-0557
Practice Address - Fax:678-288-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-05
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-12-10491103K00000X
GA1-15-19619103K00000X
GAAMFT000418106H00000X
GAMUT000049174400000X
GARBT-16-19812246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty