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General NPI Number Information
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NPI Number | 1174953780
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Entity Type | Organization
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Legal Business Name | MARIETTA ASSOCIATED PSYCHOLOGICAL SERVICES INC
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 2501 E PIEDMONT RD STE 147
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City | MARIETTA
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State | GA
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Zip | 30062-7754
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Country | US
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Telephone | 770-977-9201
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Fax | 866-884-2308
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Provider Business Mailing Address
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Address Line | 2501 E PIEDMONT RD STE 147
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City | MARIETTA
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State | GA
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Zip | 30062-7754
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Country | US
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Telephone | 770-977-9201
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Fax | 866-884-2308
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Authorized Official
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Title or Position | CEO
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Name | DR. LAURA HAYES
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Credential | ED.D
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Telephone | 770-977-9201
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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 | 1364
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License Number State | GA
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