Lifespan Psychology, P.c. | |
98 Voorhees Rd E Hamilton GA 31811-5671 | |
(954) 260-0361 | |
Not Available |
Full Name | Lifespan Psychology, P.c. |
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Speciality | Psychologist |
Location | 98 Voorhees Rd E, Hamilton, Georgia |
Authorized Official Name and Position | Kevin James Weis (CHAIRMAN) |
Authorized Official Contact | 9542600361 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lifespan Psychology, P.c. 98 Voorhees Rd E Hamilton GA 31811-5671 Ph: (706) 582-3647 | Lifespan Psychology, P.c. 98 Voorhees Rd E Hamilton GA 31811-5671 Ph: (954) 260-0361 |
NPI Number | 1003205741 |
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Provider Enumeration Date | 01/19/2015 |
Last Update Date | 01/22/2015 |
Medicare PECOS PAC ID | 0840511291 |
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Medicare Enrollment ID | O20150610001422 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003205741 | NPI | - | NPPES |
712348695A | Medicaid | GA | |
313423941A | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103G00000X | Clinical Neuropsychologist | PSY003141 (Georgia) | Secondary |
103TC2200X | Psychologist - Clinical Child & Adolescent | PSY003142 (Georgia) | Primary |
Provider Name | Kevin James Weis |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1699791541 PECOS PAC ID: 4486635570 Enrollment ID: I20080225000088 |
Provider Name | Aimee N Staley |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1063451847 PECOS PAC ID: 3173600608 Enrollment ID: I20110302000415 |
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