| Reconnect Therapeutic Associates Llc. | |
|
1264 Concord Rd Se Se Suite 106 Smyrna GA 30080-5302 | |
| (678) 424-8650 | |
| (678) 424-8653 |
| Full Name | Reconnect Therapeutic Associates Llc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1264 Concord Rd Se, Smyrna, Georgia |
| Authorized Official Name and Position | Angela Ronay Richardson (PSYCHOLOGIST) |
| Authorized Official Contact | 6784248650 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Reconnect Therapeutic Associates Llc. 1264 Concord Rd Se Ste 106 Smyrna GA 30080-5302 Ph: (678) 424-8650 | Reconnect Therapeutic Associates Llc. 1264 Concord Rd Se Se Suite 106 Smyrna GA 30080-5302 Ph: (678) 424-8650 |
| NPI Number | 1760933287 |
|---|---|
| Provider Enumeration Date | 10/19/2016 |
| Last Update Date | 10/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760933287 | NPI | - | NPPES |
| 003153870A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LPC007466 (Georgia) | Primary |
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