Healthcare Provider Details

I. General information

NPI: 1386059251
Provider Name (Legal Business Name): NEUROBEHAVIORAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 HUDSON TRCE
AUGUSTA GA
30907-2010
US

IV. Provider business mailing address

207 HUDSON TRCE
AUGUSTA GA
30907-2010
US

V. Phone/Fax

Practice location:
  • Phone: 706-823-5250
  • Fax: 706-823-5266
Mailing address:
  • Phone: 706-823-5250
  • Fax: 706-823-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC004405
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEREMY B HERTZA
Title or Position: EXEC CLINICAL DIRECTOR
Credential: PSYD
Phone: 706-823-5266