| Corcair Pyschological Services, Llc | |
|
235 E Ponce De Leon Ave Suite 110 Decatur GA 30030-3452 | |
| (404) 542-5287 | |
| (888) 485-5215 |
| Full Name | Corcair Pyschological Services, Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 235 E Ponce De Leon Ave, Decatur, Georgia |
| Authorized Official Name and Position | Jill C Anderson (OWNER) |
| Authorized Official Contact | 4045425287 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Corcair Pyschological Services, Llc 235 E Ponce De Leon Ave Suite 110 Decatur GA 30030-3452 Ph: (404) 542-5287 | Corcair Pyschological Services, Llc 235 E Ponce De Leon Ave Suite 110 Decatur GA 30030-3452 Ph: (404) 542-5287 |
| NPI Number | 1124310727 |
|---|---|
| Provider Enumeration Date | 05/14/2011 |
| Last Update Date | 05/14/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124310727 | NPI | - | NPPES |
| 003101292A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY003030 (Georgia) | Primary |
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