In Depth Therapy, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW002504 Issued in GA

Legal business name

IN DEPTH THERAPY, LLC

Practice address

485 Huntington Rd Ste 197
Athens, GA 30606-1845

Phone

(706) 201-9112

NPI assigned

Nov 29, 2017

Organization subpart

No

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

Authorized official

Name

Perry Malcolm, LCSW

Title

Owner

Phone

(706) 201-9112

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1511913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511913600000",
    "number": "1972017929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 GREENCREST DR",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306053825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 HUNTINGTON RD STE 197",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306061845",
            "telephone_number": "706-201-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IN DEPTH THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-29",
        "last_updated": "2017-11-29",
        "status": "A",
        "authorized_official_last_name": "MALCOLM",
        "authorized_official_first_name": "PERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-201-9112",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW002504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Athens, GA
• Providers in Athens, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.