| Innovative Therapy Group | |
|
690 Thornton Way Ste A Lithia Springs GA 30122-2614 | |
| (678) 324-0654 | |
| (678) 810-0841 |
| Full Name | Innovative Therapy Group |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 690 Thornton Way Ste A, Lithia Springs, Georgia |
| Authorized Official Name and Position | Juan Zermeno Desantos (PROGRAM DIRECTOR) |
| Authorized Official Contact | 4042906786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Therapy Group 690 Thornton Way Ste A Lithia Springs GA 30122-2614 Ph: (678) 324-0654 | Innovative Therapy Group 690 Thornton Way Ste A Lithia Springs GA 30122-2614 Ph: (678) 324-0654 |
| NPI Number | 1154193142 |
|---|---|
| Provider Enumeration Date | 10/24/2023 |
| Last Update Date | 10/24/2023 |
| Certification Date | 10/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154193142 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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