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General NPI Number Information
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NPI Number | 1760115554
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Entity Type | Organization
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Legal Business Name | FLYING ANCHOR PSYCHOLOGY PC
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 1959 LAKESPRINGS CIR
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City | ATLANTA
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State | GA
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Zip | 30338-4403
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Country | US
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Telephone | 312-330-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 1959 LAKESPRINGS CIR
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City | ATLANTA
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State | GA
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Zip | 30338-4403
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Country | US
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Telephone | 312-330-4321
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BETH FISCHGRUND
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Credential |
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Telephone | 312-330-4321
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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 |
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License Number State |
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