Healthcare Provider Details

I. General information

NPI: 1417281619
Provider Name (Legal Business Name): PSYCHOLOGY AND COUNSELING CENTERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FELTON PL SUITE A
CARTERSVILLE GA
30120-2153
US

IV. Provider business mailing address

17 FELTON PL SUITE A
CARTERSVILLE GA
30120-2153
US

V. Phone/Fax

Practice location:
  • Phone: 770-386-8996
  • Fax: 770-386-8100
Mailing address:
  • Phone: 770-386-8996
  • Fax: 770-386-8100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY001063
License Number StateGA

VIII. Authorized Official

Name: DR. WILLIAM B MOON
Title or Position: OWNER
Credential: PHD
Phone: 770-386-8996