Provider Demographics
NPI:1700289063
Name:ATLANTA RELATIONSHIP INSTITUTE
Entity type:Organization
Organization Name:ATLANTA RELATIONSHIP INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITBECK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LPC
Authorized Official - Phone:404-713-8749
Mailing Address - Street 1:365 NORTHRIDGE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3207
Mailing Address - Country:US
Mailing Address - Phone:770-771-6903
Mailing Address - Fax:
Practice Address - Street 1:365 NORTHRIDGE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-3207
Practice Address - Country:US
Practice Address - Phone:770-771-6903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001334106H00000X
GALPC007904101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty