| Csra Psychological Services Limited Liability Company | |
|
930 Glenhaven Dr Evans GA 30809-0445 | |
| (706) 814-6429 | |
| (706) 814-6429 |
| Full Name | Csra Psychological Services Limited Liability Company |
|---|---|
| Speciality | Clinic/Center |
| Location | 930 Glenhaven Dr, Evans, Georgia |
| Authorized Official Name and Position | Elizabeth L Edwards (OWNER) |
| Authorized Official Contact | 7068146429 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Csra Psychological Services Limited Liability Company 125 Commercial Blvd Po Box 204301 Martinez GA 30917-4301 Ph: (706) 814-6429 | Csra Psychological Services Limited Liability Company 930 Glenhaven Dr Evans GA 30809-0445 Ph: (706) 814-6429 |
| NPI Number | 1811775216 |
|---|---|
| Provider Enumeration Date | 09/18/2023 |
| Last Update Date | 09/18/2023 |
| Certification Date | 09/18/2023 |
| Medicare PECOS PAC ID | 7618311176 |
|---|---|
| Medicare Enrollment ID | O20240223000483 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811775216 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Elizabeth Lynn Edwards |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114384054 PECOS PAC ID: 8527402080 Enrollment ID: I20240223003020 |
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