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General NPI Number Information
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NPI Number | 1962176933
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Entity Type | Organization
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Legal Business Name | DEVELABILITIES
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 8015 MEADOWSWEET TRCE
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City | ROSWELL
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State | GA
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Zip | 30076-3362
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Country | US
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Telephone | 770-833-0885
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Fax |
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Provider Business Mailing Address
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Address Line | 8015 MEADOWSWEET TRCE
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City | ROSWELL
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State | GA
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Zip | 30076-3362
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JILL WAXMAN
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Credential | PHD
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Telephone | 770-833-0885
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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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