Family Art Therapy Center PC
Organization Active NPI Professional Counselor · Clayton, GA
NPI 1609916147 · NPPES record last updated Mar 13, 2023
Key facts
- NPI
- 1609916147
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC 003219 (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
- Organization subpart
- No
Authorized official
- Name
- Ms. Christy Elizabeth Black, LPC, ATR-BC
- Title
- Ceo
- Phone
- (064) 903-5357
Corporate family (same tax ID) 1
Practitioners 11
-
Christy Elizabeth Black, LPC, ATR-BC
-
Barbara H Marshall, LPC
-
Judith Ann Cole, LPC
-
Thomas Gregory Cole, LPC
-
Patti Denike, NCTMB THERAPIST
-
Evelyn Craig Edmondson, LCSW
-
Carrie McLamar, MS, LPC
-
Vicki Ann McMorrough, LPC
-
Sandra Joan Moss, LCSW
-
Kimberli Dawn Patrick, M.ED, LPC
-
Nancy B Schimp, MSW LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240304002412 | GA | Part B Supplier - Clinic/Group Practice | 6406843408 |
Receives reassigned benefits from 1 practitioner Practice locations: Clayton, GA |
National Provider Directory
- Tax ID family
- Family Art Therapy Center
Locations
621 Highway 441 S
Ste 6
Clayton, GA 30525
Phone (706) 782-0717
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | LPC 003219 | GA | Yes |
Addresses
Primary practice location
109 Old Livery Street
Clayton, GA 30525
Mailing address
PO Box 1689
Clayton, GA 30525-0043
Phone (706) 782-0717
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10045514 | Other | GA | CMO AMERIGROUP |
| 743776000 | Other | GA | CMO MAGELLAN |
| 052483465A | Medicaid | GA |
Other providers in Clayton, GA
- Emcare Physician Providers Inc.
- Irby Dell Engram Jr.
- Ermds LLC
- Esprit de Core Counseling, Inc.
- Family Art Therapy Center
- Julie Ann Farrow
- Lisa M Ferraro
- Foothills Emergency Services, LLC
- Karen J Frank
- Edward Dent Frederickson
All providers in Clayton, GA · Professional Counselor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.