Healthcare Provider Details

I. General information

NPI: 1679983019
Provider Name (Legal Business Name): ERICA BACHER, PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 LENOX POINTE NE
ATLANTA GA
30324-3169
US

IV. Provider business mailing address

1304 LANIER BLVD NE
ATLANTA GA
30306-3343
US

V. Phone/Fax

Practice location:
  • Phone: 404-862-0032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPSY003493
License Number StateGA

VIII. Authorized Official

Name: ERICA CARLIN BACHER
Title or Position: PSYCHOLOGIST
Credential:
Phone: 404-862-0032