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General NPI Number Information
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NPI Number | 1740421163
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SOURCE, INC.
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Dates
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Enumeration Date | 03/14/2009
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Last Update Date | 03/14/2009
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Provider Practice Location Address
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Address Line | 108 MARGARET AVE NE
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City | MARIETTA
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State | GA
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Zip | 30060-1306
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Country | US
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Telephone | 770-422-2009
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Fax | 770-428-0330
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Provider Business Mailing Address
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Address Line | 1126 BOULEVARD DR NE
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City | ATLANTA
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State | GA
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Zip | 30317-1504
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Country | US
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Telephone | 404-964-1146
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Fax | 404-584-7151
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Authorized Official
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Title or Position | PRESIDENT
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Name | NANCY GARFIELD
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Credential | LCSW, MSW, MPA
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Telephone | 404-964-1146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003405
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License Number State | GA
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