Organization
LAVENDER GROVE PSYCHOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EXTRIARA CHARLESH GATES LCSW (PSYCHOTHERAPIST/ OWNER)
(404) 490-0031
Entity
Organization
Contact information
Practice address
3755 REDWINE RD, ATLANTA, GA 30344-5899
(404) 490-0031
(404) 490-0031
Mailing address
3755 REDWINE RD APT 2216, ATLANTA, GA 30344-5932
(404) 490-0031
(404) 490-0031
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
07/27/2020
Last updated
07/27/2020
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