Provider Demographics
NPI:1619746534
Name:ATLANTA TRAUMA THERAPY & CONSULTING
Entity type:Organization
Organization Name:ATLANTA TRAUMA THERAPY & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDEIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:470-659-0607
Mailing Address - Street 1:3158 DEMOONEY RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1130
Mailing Address - Country:US
Mailing Address - Phone:470-659-0607
Mailing Address - Fax:
Practice Address - Street 1:3158 DEMOONEY RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-1130
Practice Address - Country:US
Practice Address - Phone:470-659-0607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty