Organization
GENERATIVE THERAPY CENTER LLC
Active
Other names
GENERATIVE THERAPY CENTER, MICHEL BORDEAU LCSW
Organization subpart
No
Provider details
NPI number
Authorized official
MICHEL BORDEAU LCSW (OWNER)
(646) 582-9774
Entity
Organization
Contact information
Practice address
968 SUMMIT LN, ELLIJAY, GA 30540-8728
(646) 582-9774
Mailing address
968 SUMMIT LN # 1042, ELLIJAY, GA 30540-8728
(646) 582-9774
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW006489
PROFESSIONAL LICENSE
GA
Enumeration date
09/21/2018
Last updated
05/17/2019
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