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General NPI Number Information
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NPI Number | 1437323029
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Entity Type | Organization
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Legal Business Name | SBS PSYCHOLOGICAL ASSOCIATES
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 485 S PERRY ST SUITE D
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-4923
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Country | US
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Telephone | 678-205-0838
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2133
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-2133
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SHIRLEY BOONE-SANFORD
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Credential | PH.D.
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Telephone | 678-205-0838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 002451
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License Number State | GA
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