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General NPI Number Information
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NPI Number | 1053650689
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Entity Type | Organization
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Legal Business Name | ROY L. DIAL III, LMFT, PH.D., PC
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 11807 NORTHFALL LN SUITE 901
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City | ALPHARETTA
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State | GA
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Zip | 30009-7977
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Country | US
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Telephone | 678-596-0773
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Fax |
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Provider Business Mailing Address
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Address Line | 11807 NORTHFALL LN SUITE 901
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City | ALPHARETTA
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State | GA
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Zip | 30009-7977
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Country | US
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Telephone | 678-596-0773
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROY L DIAL
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Credential | LMFT PH.D.
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Telephone | 678-596-0773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT000748
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License Number State | GA
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