Healthcare Provider Details

I. General information

NPI: 1306493440
Provider Name (Legal Business Name): ONWARD AND OUTWARD PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209B SWANTON WAY STE 204
DECATUR GA
30030-3271
US

IV. Provider business mailing address

229 WOODVIEW DR
DECATUR GA
30030-1038
US

V. Phone/Fax

Practice location:
  • Phone: 678-561-4187
  • Fax:
Mailing address:
  • Phone: 540-846-0932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JANELLE SUMMERVILLE PEIFER
Title or Position: OWNER AND CHIEF PSYCHOLOGIST
Credential: PHD
Phone: 540-846-0932