Provider Demographics
NPI:1700580784
Name:DOUBLE THERAPY, LLC
Entity Type:Organization
Organization Name:DOUBLE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:478-955-2699
Mailing Address - Street 1:103 GRAY FOX XING
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3398
Mailing Address - Country:US
Mailing Address - Phone:478-955-2699
Mailing Address - Fax:
Practice Address - Street 1:103 GRAY FOX XING
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3398
Practice Address - Country:US
Practice Address - Phone:478-955-2699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty