Organization
A GROWTH PLACE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY T. SAMPLES LCSW (PRESIDENT)
(770) 506-9575
Entity
Organization
Contact information
Practice address
10 WILSON RD, SUITE 1, STOCKBRIDGE, GA 30281-4433
(770) 506-9575
(770) 506-9369
Mailing address
10 WILSON RD, SUITE 1, STOCKBRIDGE, GA 30281-4433
(770) 506-9575
(770) 506-9369
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT000125
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301563086A
—
GA
Enumeration date
03/06/2007
Last updated
11/30/2011
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