=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982412599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONYX PSYCHOLOGICAL SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2024
-----------------------------------------------------
Last Update Date | 12/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1223 AUGUSTA WEST PKWY STE 22
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30909-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-624-4125
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 336 GEORGIA AVE STE 106-193
-----------------------------------------------------
City | NORTH AUGUSTA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29841-3849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. ERICA JAMES YOUNG
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 803-206-0839
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------