Organization
MODERN THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBYN J KELLY MSW,LISW (OWNER)
(513) 449-0445
Entity
Organization
Contact information
Practice address
1210 FOUNTAIN COVE LN, LAWRENCEVILLE, GA 30043-3974
(513) 449-0445
(513) 672-9859
Mailing address
1210 FOUNTAIN COVE LN, LAWRENCEVILLE, GA 30043-3974
(513) 449-0445
(513) 672-9859
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225280142
—
OH
Enumeration date
02/10/2023
Last updated
02/10/2023
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