| Coastal Georgia Psychodynamic Center, Llc | |
|
325 S Walnut St Statesboro GA 30458-5418 | |
| (912) 421-9050 | |
| (912) 623-4918 |
| Full Name | Coastal Georgia Psychodynamic Center, Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 325 S Walnut St, Statesboro, Georgia |
| Authorized Official Name and Position | Amanda Rickard (ORGANIZER) |
| Authorized Official Contact | 9124219050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Georgia Psychodynamic Center, Llc 325 S Walnut St Statesboro GA 30458-5418 Ph: (912) 421-9050 | Coastal Georgia Psychodynamic Center, Llc 325 S Walnut St Statesboro GA 30458-5418 Ph: (912) 421-9050 |
| NPI Number | 1871033654 |
|---|---|
| Provider Enumeration Date | 02/28/2017 |
| Last Update Date | 05/11/2020 |
| Certification Date | 05/11/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871033654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY003907 (Georgia) | Primary |
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