Provider Demographics
NPI:1932511144
Name:ADVANCE THERAPEUTIC CONCEPTS, INC.
Entity Type:Organization
Organization Name:ADVANCE THERAPEUTIC CONCEPTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SCHANTATE
Authorized Official - Middle Name:O
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:678-344-7836
Mailing Address - Street 1:2795 MAIN ST W
Mailing Address - Street 2:SUITE 20B
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3164
Mailing Address - Country:US
Mailing Address - Phone:678-344-7836
Mailing Address - Fax:678-892-8575
Practice Address - Street 1:2795 MAIN ST W
Practice Address - Street 2:SUITE 20B
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3164
Practice Address - Country:US
Practice Address - Phone:678-344-7836
Practice Address - Fax:678-892-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health