Provider Demographics
NPI:1235973488
Name:PLAYHEALS-A THERAPEUTIC COUNSELING FACILITY
Entity type:Organization
Organization Name:PLAYHEALS-A THERAPEUTIC COUNSELING FACILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHASSITY
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, NCC, ACS
Authorized Official - Phone:678-431-0064
Mailing Address - Street 1:1885 WESTON LN
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5503
Mailing Address - Country:US
Mailing Address - Phone:678-431-0064
Mailing Address - Fax:
Practice Address - Street 1:1885 WESTON LN
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5503
Practice Address - Country:US
Practice Address - Phone:678-431-0064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-22
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1275286544Medicaid