Organization
INNOVATIVE THERAPY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUAN ZERMENO DESANTOS (PROGRAM DIRECTOR)
(404) 290-6786
Entity
Organization
Contact information
Practice address
690 THORNTON WAY STE A, LITHIA SPRINGS, GA 30122-2614
(678) 324-0654
(678) 810-0841
Mailing address
690 THORNTON WAY STE A, LITHIA SPRINGS, GA 30122-2614
(678) 324-0654
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
10/24/2023
Last updated
10/24/2023
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