Provider Demographics
NPI:1013665025
Name:PURPOSE AND LIVING PSYCHOTHERAPY SERVICES
Entity Type:Organization
Organization Name:PURPOSE AND LIVING PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-485-9069
Mailing Address - Street 1:3625 RIFFLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2596
Mailing Address - Country:US
Mailing Address - Phone:770-679-8454
Mailing Address - Fax:
Practice Address - Street 1:561 THORNTON RD STE V
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-1558
Practice Address - Country:US
Practice Address - Phone:770-485-9069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003166564Medicaid