NPIMap

Organization Active NPI

Family Art Therapy Center PC

  • Professional Counselor
  • Clayton, GA
National Provider Identifier
1609916147
Registry record updated Mar 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC 003219 Issued in GA
Legal business name
FAMILY ART THERAPY CENTER PC
Practice address
109 Old Livery Street
Clayton, GA 30525
Phone
(706) 782-0717
Fax
(706) 782-5266
NPI assigned
Feb 7, 2007
Last updated
Mar 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Christy Elizabeth Black, LPC, ATR-BCNPI 1346380946
Title
Ceo
Phone
(064) 903-5357

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X LPC 003219 GA Primary

Addresses

Primary practice location

109 Old Livery Street
Clayton, GA 30525

Mailing address

PO Box 1689
Clayton, GA 30525-0043
Phone (706) 782-0717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240304002412 GA Part B Supplier - Clinic/Group Practice 6406843408 Receives reassigned benefits from 1 practitioner
Practice locations: Clayton, GA

National Provider Directory

National Provider Directory
Tax ID family
Family Art Therapy Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

621 Highway 441 S
Ste 6
Clayton, GA 30525
Phone (706) 782-0717

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1609916147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1689",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305250043",
            "telephone_number": "706-782-0717",
            "fax_number": "706-782-5266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 OLD LIVERY STREET",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "30525",
            "telephone_number": "706-782-0717",
            "fax_number": "706-782-5266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY ART THERAPY CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "064-903-5357",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC, ATR-BC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC 003219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.