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General NPI Number Information
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NPI Number | 1891987590
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Entity Type | Organization
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Legal Business Name | GEORGIA PSYCHOLOGICAL CONSULTANTS
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 600 KENNESAW AVE NW SUITE 300
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City | MARIETTA
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State | GA
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Zip | 30060-6988
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Country | US
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Telephone | 770-428-6698
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 WHITLOCK AVE NW SUITE 320
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City | MARIETTA
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State | GA
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Zip | 30064-5455
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Country | US
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Telephone | 770-428-6698
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CLINICAL PSYCHOLOGIST
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Name | DR. LEISA ANN BAILEY
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Credential | PHD
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Telephone | 770-428-6698
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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 | 999
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License Number State | GA
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