Healthcare Provider Details

I. General information

NPI: 1760999767
Provider Name (Legal Business Name): ALESYA KOREY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 POWDER SPRINGS ST STE E31
MARIETTA GA
30064-3563
US

IV. Provider business mailing address

540 POWDER SPRINGS ST STE E31
MARIETTA GA
30064-3563
US

V. Phone/Fax

Practice location:
  • Phone: 404-862-8106
  • Fax:
Mailing address:
  • Phone: 404-862-8106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY3835
License Number StateGA

VIII. Authorized Official

Name: ALESYA KOREY
Title or Position: CLINICAL PSYCHOLOGIST
Credential:
Phone: 404-862-8106