| Life Transformation Psychological Center, Pc | |
|
1755 N Brown Rd Suite 200 Lawrenceville GA 30043-8198 | |
| (706) 530-1504 | |
| (855) 420-6045 |
| Full Name | Life Transformation Psychological Center, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 1755 N Brown Rd, Lawrenceville, Georgia |
| Authorized Official Name and Position | Elizabeth L. Anderson (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 7065301504 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Transformation Psychological Center, Pc 950 Herrington Rd Suite C 186 Lawrenceville GA 30044-7217 Ph: (706) 530-1504 | Life Transformation Psychological Center, Pc 1755 N Brown Rd Suite 200 Lawrenceville GA 30043-8198 Ph: (706) 530-1504 |
| NPI Number | 1285024810 |
|---|---|
| Provider Enumeration Date | 02/03/2015 |
| Last Update Date | 02/03/2015 |
| Medicare PECOS PAC ID | 0840501698 |
|---|---|
| Medicare Enrollment ID | O20150619000901 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285024810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY003783 (Georgia) | Primary |
| Provider Name | Elizabeth L Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1619303385 PECOS PAC ID: 0244462521 Enrollment ID: I20140625002144 |
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