| Transformative Therapy Group Llc | |
|
1230 Caroline St Ne Ste B-210 Atlanta GA 30307-2751 | |
| (470) 377-5990 | |
| Not Available |
| Full Name | Transformative Therapy Group Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1230 Caroline St Ne Ste B-210, Atlanta, Georgia |
| Authorized Official Name and Position | Shadonna Davis (CEO) |
| Authorized Official Contact | 4703775990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Transformative Therapy Group Llc 1702 Boulder Walk Ln Se Atlanta GA 30316-3991 Ph: (770) 789-5063 | Transformative Therapy Group Llc 1230 Caroline St Ne Ste B-210 Atlanta GA 30307-2751 Ph: (470) 377-5990 |
| NPI Number | 1114559549 |
|---|---|
| Provider Enumeration Date | 02/04/2020 |
| Last Update Date | 06/19/2020 |
| Certification Date | 06/19/2020 |
| Medicare PECOS PAC ID | 9830511880 |
|---|---|
| Medicare Enrollment ID | O20200619000728 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114559549 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shadonna Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821629403 PECOS PAC ID: 3779905732 Enrollment ID: I20200619001442 |
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