Organization
GENERATIVE THERAPY CENTER LLC
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up