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General NPI Number Information
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NPI Number | 1710039839
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Entity Type | Organization
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Legal Business Name | CANDLER PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 66 N ROUNTREE ST
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City | METTER
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State | GA
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Zip | 30439-4019
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Country | US
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Telephone | 912-685-6259
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Fax | 912-685-9871
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Provider Business Mailing Address
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Address Line | PO BOX 1146 66 NORTH ROUNTREE STREET
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City | METTER
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State | GA
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Zip | 30439-1146
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Country | US
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Telephone | 912-685-6259
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Fax | 912-685-9871
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. SUSAN DAUGHTRY FERRELL
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Credential | PH.D.
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Telephone | 912-685-6259
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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 | 001780
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License Number State | GA
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