| A Growth Place, Inc. | |
|
10 Wilson Rd Suite 1 Stockbridge GA 30281-4433 | |
| (770) 506-9575 | |
| (770) 506-9369 |
| Full Name | A Growth Place, Inc. |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 10 Wilson Rd, Stockbridge, Georgia |
| Authorized Official Name and Position | Gregory T. Samples (PRESIDENT) |
| Authorized Official Contact | 7705069575 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| A Growth Place, Inc. 10 Wilson Rd Suite 1 Stockbridge GA 30281-4433 Ph: (770) 506-9575 | A Growth Place, Inc. 10 Wilson Rd Suite 1 Stockbridge GA 30281-4433 Ph: (770) 506-9575 |
| NPI Number | 1073643482 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 11/30/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073643482 | NPI | - | NPPES |
| 301563086A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | MFT000125 (Georgia) | Primary |
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