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General NPI Number Information
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NPI Number | 1114196912
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Entity Type | Organization
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Legal Business Name | AUSBORN BEHAVIORAL CARE, PC
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 2295 PARKLAKE DRIVE, N.E. SUITE 545
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City | ATLANTA
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State | GA
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Zip | 30345-2950
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Country | US
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Telephone | 770-938-4616
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Fax | 855-932-4901
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Provider Business Mailing Address
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Address Line | 2295 PARKLAKE DRIVE, N.E. SUITE 545
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City | ATLANTA
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State | GA
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Zip | 30345-2950
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Country | US
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Telephone | 770-938-4616
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Fax | 855-932-4901
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Authorized Official
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Title or Position | VICE PRESIDENT/CHIEF FINANCIAL OFFI
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Name | DR. DENELLA LAZENBY-AUSBORN
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Credential | PSY.D.
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Telephone | 770-938-4616
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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 |
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License Number State |
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