Provider Demographics
NPI:1487479895
Name:EMERALD INTEGRATIVE THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:EMERALD INTEGRATIVE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MCCRORIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-983-5910
Mailing Address - Street 1:2992 MABRY RD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-4701
Mailing Address - Country:US
Mailing Address - Phone:404-983-5910
Mailing Address - Fax:
Practice Address - Street 1:5825 GLENRIDGE DR STE 110
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:678-439-6564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)