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General NPI Number Information
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NPI Number | 1306072954
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Entity Type | Organization
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Legal Business Name | METRO ATLANTA PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 5825 GLENRIDGE DR NE BLDG. 2, ST.E. 120
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City | ATLANTA
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State | GA
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Zip | 30328-5387
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Country | US
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Telephone | 404-303-1935
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Fax | 404-303-8488
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Provider Business Mailing Address
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Address Line | 5825 GLENRIDGE DR NE BLDG. 2, ST.E. 120
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City | ATLANTA
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State | GA
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Zip | 30328-5387
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Country | US
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Telephone | 404-303-1935
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Fax | 404-303-8488
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Authorized Official
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Title or Position | CO-PRESIDENT
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Name | MRS. NANCY WASSERMAN LOEB
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Credential | M.S., L.P.C.
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Telephone | 770-417-2732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC001688
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC003775
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC002966
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW001624
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY002865
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License Number State | GA
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