Healthcare Provider Details

I. General information

NPI: 1821825712
Provider Name (Legal Business Name): RSA PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 OFFICE PARK DR
DOUGLASVILLE GA
30134-6936
US

IV. Provider business mailing address

8316 OFFICE PARK DR
DOUGLASVILLE GA
30134-6936
US

V. Phone/Fax

Practice location:
  • Phone: 470-336-3650
  • Fax:
Mailing address:
  • Phone: 470-336-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: KAITLYN APPEL
Title or Position: CO OWNER
Credential: LPC
Phone: 470-366-3650