Organization
MARIETTA COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE M TIDWELL MFT (THERAPIST)
(678) 677-7484
Entity
Organization
Contact information
Practice address
2440 SANDY PLAINS RD, BLDG #25, MARIETTA, GA 30066-7217
(770) 971-9311
Mailing address
2440 SANDY PLAINS RD, BLDG #25, MARIETTA, GA 30066-7217
(770) 971-9311
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
NOT ISSUED YET
GA
Other
Enumeration date
10/20/2016
Last updated
10/20/2016
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