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General NPI Number Information
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NPI Number | 1093802233
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL CONSULTANTS OF MARIETTA, PC
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 600 KENNESAW AVE NW SUITE 300
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City | MARIETTA
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State | GA
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Zip | 30060-6988
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Country | US
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Telephone | 770-420-9448
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Fax |
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Provider Business Mailing Address
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Address Line | 600 KENNESAW AVE NW SUITE 300
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City | MARIETTA
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State | GA
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Zip | 30060-6988
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Country | US
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Telephone | 770-420-9448
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK MANFRED ROLAND
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Credential | PH.D.
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Telephone | 770-420-9448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1872
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 897
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License Number State | GA
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