Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lavender Grove Psychotherapy

Organization Clinical Social Worker · NPI 1407465354

Lavender Grove Psychotherapy is a Clinical Social Worker in Atlanta, Georgia. Registered with an NPI since 2020.

In the registry since
2020

Practice location Address checks out

3755 Redwine Rd
Atlanta, GA 30344-5899
Phone: (404) 490-0031
Fax: (404) 490-0031
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1407465354
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Extriara Gates — Psychotherapist/ Owner · (404) 490-0031
NPI enumeratedJuly 27, 2020
Last updated in NPPESJuly 27, 2020
Certification dateJuly 27, 2020
Mailing address3755 Redwine Rd Apt 2216, Atlanta, GA 30344-5932

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