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General NPI Number Information
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NPI Number | 1457628653
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND PSYCHOLOGICAL SERVICE, LLC
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 3580 OLD MILTON PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30005-4465
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Country | US
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Telephone | 678-667-3565
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Fax | 404-443-0926
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Provider Business Mailing Address
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Address Line | 3580 OLD MILTON PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30005-4465
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Country | US
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Telephone | 678-667-3565
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Fax | 404-443-0926
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Authorized Official
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Title or Position | OWNER
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Name | BRIANNA GAYNOR
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Credential | PSY.D.
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Telephone | 678-667-3565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY003462
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License Number State | GA
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