Provider Demographics
NPI:1639561905
Name:THE ITD GROUP LLC
Entity type:Organization
Organization Name:THE ITD GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ SPECIAL EDUCATOR
Authorized Official - Prefix:
Authorized Official - First Name:VEJA
Authorized Official - Middle Name:CORENE
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:678-905-1500
Mailing Address - Street 1:95 PARTRIDGE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-1185
Mailing Address - Country:US
Mailing Address - Phone:678-905-1500
Mailing Address - Fax:978-374-3908
Practice Address - Street 1:2004 EASTVIEW PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5770
Practice Address - Country:US
Practice Address - Phone:678-905-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency