| Weeping Willow Therapy Group Llc | |
|
1970 Main St E Ste B53 Snellville GA 30078-6463 | |
| (404) 513-8839 | |
| Not Available |
| Full Name | Weeping Willow Therapy Group Llc |
|---|---|
| Speciality | Counselor |
| Location | 1970 Main St E Ste B53, Snellville, Georgia |
| Authorized Official Name and Position | Brandon Davis (ADMINISTRATOR) |
| Authorized Official Contact | 4045138839 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Weeping Willow Therapy Group Llc 1970 Main St E Ste B53 Snellville GA 30078-6463 Ph: () - | Weeping Willow Therapy Group Llc 1970 Main St E Ste B53 Snellville GA 30078-6463 Ph: (404) 513-8839 |
| NPI Number | 1376255448 |
|---|---|
| Provider Enumeration Date | 12/20/2022 |
| Last Update Date | 12/07/2023 |
| Certification Date | 12/07/2023 |
| Medicare PECOS PAC ID | 6709239445 |
|---|---|
| Medicare Enrollment ID | O20240129003314 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376255448 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Shelbie Samantha Hilliard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730863762 PECOS PAC ID: 8224481973 Enrollment ID: I20240129003840 |
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