MEDICARE: DALTON PSYCHOLOGY ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY003536	GA

General Provider Information

NPI Number	:	1275807976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALTON PSYCHOLOGY ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	1807 CANTERBURY NW
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-7035
Country	:	US
Telephone Number	:	706-229-9080
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 CHATTANOOGA AVE
Second Line	:	SUITE 3
City	:	DALTON
State	:	GA
Zip	:	30720-2671
Country	:	US
Telephone Number	:	423-421-6028
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENNETH D NEAL
Credential	:	PSY.D.
Telephone Number	:	423-421-6028

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	02/18/2025

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