Provider Demographics
NPI:1366576050
Name:ALLIANCE FOR CHANGE THROUGH TREATMENT, LLC
Entity type:Organization
Organization Name:ALLIANCE FOR CHANGE THROUGH TREATMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON-LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:678-406-9707
Mailing Address - Street 1:3524 HABERSHAM AT NORTHLAKE
Mailing Address - Street 2:BLDG. A
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4009
Mailing Address - Country:US
Mailing Address - Phone:678-406-9707
Mailing Address - Fax:678-406-9881
Practice Address - Street 1:3524 HABERSHAM AT NORTHLAKE
Practice Address - Street 2:BLDG. A
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4009
Practice Address - Country:US
Practice Address - Phone:678-406-9707
Practice Address - Fax:678-406-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health