Healthcare Provider Details

I. General information

NPI: 1710709886
Provider Name (Legal Business Name): REACH HIGHER PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 BRIDGEGATE CT NE
MARIETTA GA
30068-2201
US

IV. Provider business mailing address

1027 BRIDGEGATE CT NE
MARIETTA GA
30068-2201
US

V. Phone/Fax

Practice location:
  • Phone: 412-716-2345
  • Fax:
Mailing address:
  • Phone: 412-716-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ADDAM JOSEPH WAWRZONEK
Title or Position: OWNER
Credential: PHD
Phone: 412-716-2345