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General NPI Number Information
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NPI Number | 1679624183
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Entity Type | Organization
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Legal Business Name | KIDS ON THE MOVE, LLC
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3500 PIEDMONT RD NE STE 211
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City | ATLANTA
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State | GA
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Zip | 30305-1559
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Country | US
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Telephone | 404-846-2600
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Fax | 404-846-2700
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Provider Business Mailing Address
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Address Line | 3500 PIEDMONT RD NE STE 211
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City | ATLANTA
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State | GA
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Zip | 30305-1559
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Country | US
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Telephone | 404-846-2600
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Fax | 404-846-2700
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. DEBRA KIM ROBERTS
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Credential | PH.D.
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Telephone | 404-846-2600
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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 | 002616
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License Number State | GA
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