OrganizationActive
Innovative Therapy Services
NPI 1134460363 · Early Intervention Provider Agency · Stone Mountain, GA
Provider details
- NPI number
- 1134460363
- Entity type
- Organization
- Primary specialty
- Early Intervention Provider AgencyAgencies
- Organization subpart
- No
- Authorized official
- Tasha Winns, Speech Pathologist(301) 646-0304
- License
- SLP007594 (GA)
Specialties & taxonomies
Agencies
Practice location
632 Tahoe Cir
Stone Mountain, GA 30083-4450
Phone: (301) 646-0304
Approximate (ZIP-level) locationGet directions
Mailing address
632 Tahoe Cir
Stone Mountain, GA 30083-4450
Registry dates
- Enumerated
- 2013-03-13
- Last updated
- 2013-03-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.