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General NPI Number Information
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NPI Number | 1932430196
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Entity Type | Organization
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Legal Business Name | MARIA C. SANTANA,LLC
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 5440 LAWRENCEVILLE HWY
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City | LILBURN
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State | GA
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Zip | 30047
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Country | US
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Telephone | 770-925-7898
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Fax | 770-925-7873
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Provider Business Mailing Address
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Address Line | 3315 FRANCINE DR
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City | DECATUR
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State | GA
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Zip | 30033
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Country | US
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Telephone | 404-428-6084
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Fax | 770-925-7873
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MARIA CARMEN SANTANA
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Credential | PHD
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Telephone | 770-925-7898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY003121
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License Number State | GA
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