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General NPI Number Information
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NPI Number | 1588925796
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Entity Type | Organization
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Legal Business Name | STANDARD OF CARE PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 3915 CASCADE RD SW # T90
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City | ATLANTA
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State | GA
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Zip | 30331-8512
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Country | US
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Telephone | 678-973-2491
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Fax |
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Provider Business Mailing Address
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Address Line | 3915 CASCADE RD SW # T90
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City | ATLANTA
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State | GA
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Zip | 30331-8512
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Country | US
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Telephone | 678-973-2491
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED PSYCHOLOGIST
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Name | RAUSHANNAH JOHNSON-VERWAYNE
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Credential | PSY
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Telephone | 678-973-2491
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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 | PSY003324
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License Number State | GA
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