Provider Demographics
NPI:1922642644
Name:THERAPEUTIC ALLIES
Entity Type:Organization
Organization Name:THERAPEUTIC ALLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTER AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES CELEDON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:404-955-3306
Mailing Address - Street 1:4221 GRAVITT PL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4385
Mailing Address - Country:US
Mailing Address - Phone:404-955-3306
Mailing Address - Fax:
Practice Address - Street 1:540 POWDER SPRINGS ST STE C17
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3561
Practice Address - Country:US
Practice Address - Phone:404-642-8381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health