Provider Demographics
NPI:1548228281
Name:ATLANTA PSYCHOTHERAPY
Entity type:Organization
Organization Name:ATLANTA PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-389-1925
Mailing Address - Street 1:175 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 200-E
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9054
Mailing Address - Country:US
Mailing Address - Phone:770-389-1925
Mailing Address - Fax:770-389-3077
Practice Address - Street 1:175 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 200-E
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9054
Practice Address - Country:US
Practice Address - Phone:770-389-1925
Practice Address - Fax:770-389-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASAP 10384101YA0400X
GACSW 002841101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA835815715AMedicaid
GA835815715AMedicaid
GA80BBFNZMedicare ID - Type Unspecified