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Organization

TANYA THERIOT, PSY.D., P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TANYA SAPORITA THERIOT PSY.D. (OWNER, CLINICAL PSYCHOLOGIST)
(770) 310-1792
Entity
Organization

Contact information

Practice address
3939 ROSWELL RD, SUITE 185, MARIETTA, GA 30062-6251
(770) 310-1792
(770) 945-1211
Mailing address
PO BOX 724384, ATLANTA, GA 31139-1384
(770) 310-1792
(404) 945-1211

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY002887
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
409047010A
GU
Enumeration date
09/01/2009
Last updated
09/01/2009
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