MEDICARE: PEACHTREE PSYCHOTHERAPY, P.C.

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	103TC1900X	Counseling Psychologist	2310	GA

General Provider Information

NPI Number	:	1851414676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACHTREE PSYCHOTHERAPY, P.C.

Provider Business Mailing Address
First Line	:	6740 JAMESTOWN DR
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3030
Country	:	US
Telephone Number	:	404-735-2399
Fax Number	:	678-339-1222

Provider Business Practice Location Address
First Line	:	6740 JAMESTOWN DR
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3030
Country	:	US
Telephone Number	:	404-735-2399
Fax Number	:	678-339-1222

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA DINGLER
Credential	:	PH.D
Telephone Number	:	404-735-2399

Provider Enumeration Date	:	04/08/2007
Last Update Date	:	07/11/2011

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