Healthcare Provider Details

I. General information

NPI: 1982377206
Provider Name (Legal Business Name): UNITED PSYCHOLOGY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 COMMERCE PKWY UNIT A
CORNELIA GA
30531-5473
US

IV. Provider business mailing address

2900 CHAMBLEE TUCKER RD BLDG 16
ATLANTA GA
30341-4148
US

V. Phone/Fax

Practice location:
  • Phone: 404-806-4524
  • Fax: 770-212-2203
Mailing address:
  • Phone: 770-939-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA LUE
Title or Position: CFO
Credential:
Phone: 770-939-1288