Healthcare Provider Details

I. General information

NPI: 1760726160
Provider Name (Legal Business Name): KLEIMAN-BALASABAS PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 POWERS FERRY RD SE BUILDING 22, SUITE 200
ATLANTA GA
30339-5621
US

IV. Provider business mailing address

1652 CASWELL PKWY
MARIETTA GA
30060-9271
US

V. Phone/Fax

Practice location:
  • Phone: 770-605-7153
  • Fax: 770-953-4640
Mailing address:
  • Phone: 770-605-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY003409
License Number StateGA

VIII. Authorized Official

Name: DR. LINDSAY D KLEIMAN
Title or Position: PSYCHOLOGIST
Credential: PSY.D.
Phone: 770-605-7153