Organization
EXPRESSIVE THERAPY INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNAI LOPEZ TAVIRA CRUZ LMFT (CHILD & FAMILY THERAPIST)
(770) 361-4607
Entity
Organization
Contact information
Practice address
6015 ATLANTIC BLVD STE A, NORCROSS, GA 30071-1343
(770) 361-4607
Mailing address
824 WHITEHAVEN LN, LAWRENCEVILLE, GA 30043-6666
(770) 361-4607
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
MFT001573
GA
Other
Enumeration date
09/25/2017
Last updated
04/03/2019
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