Provider Demographics
NPI:1770105587
Name:ATK MARRIAGE AND FAMILY COACHING, LLC
Entity type:Organization
Organization Name:ATK MARRIAGE AND FAMILY COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE & FAMILY THERAPIS
Authorized Official - Prefix:
Authorized Official - First Name:KEYNIA
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:HARDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:678-609-8203
Mailing Address - Street 1:863 DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-3679
Mailing Address - Country:US
Mailing Address - Phone:678-609-8203
Mailing Address - Fax:
Practice Address - Street 1:8218 HAZELBRAND RD NE STE A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1516
Practice Address - Country:US
Practice Address - Phone:678-609-8203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty