Organization
FAMILY ART THERAPY CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTY ELIZABETH BLACK LPC, ATR-BC (CEO)
(064) 903-5357
Entity
Organization
Contact information
Practice address
109 OLD LIVERY STREET, CLAYTON, GA 30525
(706) 782-0717
(706) 782-5266
Mailing address
PO BOX 1689, CLAYTON, GA 30525-0043
(706) 782-0717
(706) 782-5266
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC 003219
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052483465A
—
GA
01
—
10045514
CMO AMERIGROUP
GA
01
—
743776000
CMO MAGELLAN
GA
Enumeration date
02/07/2007
Last updated
03/13/2023
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