Organization
DIVE THERAPY & CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SPESHAL T.W. GAUTIER PHD (OWNER)
(404) 800-1998
Entity
Organization
Contact information
Practice address
1055 HOWELL MILL RD NW FL 8, ATLANTA, GA 30318-5557
(404) 800-1998
(404) 393-0989
Mailing address
1700 NORTHSIDE DR NW STE A7, PMB 1704, ATLANTA, GA 30318-2695
(404) 800-1998
(404) 393-0989
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
09/03/2024
Last updated
09/12/2024
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