Healthcare Provider Details

I. General information

NPI: 1770218638
Provider Name (Legal Business Name): YOUNG FOLK PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/23/2022
Certification Date: 07/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 CLAIREMONT AVE
DECATUR GA
30030-1207
US

IV. Provider business mailing address

1123 CLAIREMONT AVE
DECATUR GA
30030-1207
US

V. Phone/Fax

Practice location:
  • Phone: 678-837-6529
  • Fax:
Mailing address:
  • Phone: 678-837-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN B TRAYLOR-ADOLPH
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD, LPC
Phone: 678-837-6529