Organization
INNOVATIVE THERAPY OF GEORGIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELENA DAVIS LPC (OWNER)
(866) 377-5454
Entity
Organization
Contact information
Practice address
2470 WINDY HILL RD SE, SUITE 300, MARIETTA, GA 30067-8613
(866) 377-5454
Mailing address
2470 WINDY HILL RD SE, SUITE 300, MARIETTA, GA 30067-8613
(866) 377-5454
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
007825
GA
Other
Enumeration date
09/22/2014
Last updated
09/22/2014
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