Healthcare Provider Details

I. General information

NPI: 1568527505
Provider Name (Legal Business Name): NORTHSIDE PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 N POINT PKWY SUITE 256
ALPHARETTA GA
30022-1142
US

IV. Provider business mailing address

PO BOX 250
ALPHARETTA GA
30009-0250
US

V. Phone/Fax

Practice location:
  • Phone: 770-667-3877
  • Fax: 770-667-3879
Mailing address:
  • Phone: 770-667-3877
  • Fax: 770-667-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: EMILY REDMAN
Title or Position: CIO
Credential:
Phone: 678-367-7515