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General NPI Number Information
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NPI Number | 1396580163
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Entity Type | Organization
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Legal Business Name | DMHG PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 06/25/2024
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 1775 PARKER ROAD SUITE 210
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City | CONYERS
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State | GA
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Zip | 30094
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Country | US
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Telephone | 478-284-3985
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Fax |
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Provider Business Mailing Address
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Address Line | 950 EAGLES LANDING PKWY STE 321
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7343
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Country | US
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Telephone | 478-284-3985
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST / OWNER
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Name | DR. MARY DECRUISE-OATES
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Credential | PSY.D
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Telephone | 478-284-3985
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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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