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General NPI Number Information
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NPI Number | 1093978728
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN PSYCHOLOGICAL CONSULTANT
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 7362 EAGLE CT
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City | MIDLAND
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State | GA
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Zip | 31820-4334
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Country | US
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Telephone | 706-325-0820
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Fax | 706-568-1948
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Provider Business Mailing Address
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Address Line | 7362 EAGLE CT.
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City | MIDLAND
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State | GA
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Zip | 31820-4334
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Country | US
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Telephone | 706-325-0820
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Fax | 706-568-1948
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Authorized Official
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Title or Position | PRESIDENT PSYCHOLOGIST
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Name | DR. SCOTT J STEWART
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Credential | PH D
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Telephone | 706-325-0820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2505
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 711
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 711
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2505
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License Number State | GA
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