Organization
FLYING CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISSA B CORCORAN (EXECUTIVE DIRECTOR)
(404) 512-0834
Entity
Organization
Contact information
Practice address
4680 POLO LN SE, ATLANTA, GA 30339-5346
(404) 512-0834
(770) 832-3969
Mailing address
4680 POLO LN SE, ATLANTA, GA 30339-5346
(404) 512-0834
(770) 832-3969
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
12/30/2010
Last updated
12/30/2010
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