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General NPI Number Information
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NPI Number | 1639422603
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Entity Type | Organization
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Legal Business Name | FAMILY AND CHILD DEVELOPMENT CENTER OF JOHNS CREEK LTD
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 360 PROSPECT PL
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City | ALPHARETTA
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State | GA
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Zip | 30005-5467
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Country | US
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Telephone | 404-433-7363
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Fax | 770-645-9281
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Provider Business Mailing Address
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Address Line | 500 ARGYLL CRST
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City | ALPHARETTA
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State | GA
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Zip | 30022-6118
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Country | US
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Telephone | 404-433-7363
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Fax | 770-645-9281
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Authorized Official
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Title or Position | OWNER
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Name | DR. LUCINDA TAYLOR GRAPENTHIN
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Credential |
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Telephone | 404-433-7363
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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 | 2289
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License Number State | GA
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