Healthcare Provider Details

I. General information

NPI: 1558695577
Provider Name (Legal Business Name): PSYCHOLOGICAL SCIENCES INST P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 STATE BRIDGE RD STE 110
DULUTH GA
30097-8228
US

IV. Provider business mailing address

6015 STATE BRIDGE RD APT 12206
DULUTH GA
30097-8225
US

V. Phone/Fax

Practice location:
  • Phone: 770-813-0404
  • Fax: 770-232-9043
Mailing address:
  • Phone: 770-813-0404
  • Fax: 770-232-9043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1464
License Number StateGA

VIII. Authorized Official

Name: SONYA BOSWELL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 770-813-0404