| Full Name | |
|---|---|
| Speciality | Psychologist - Forensic |
| Location | 639 13th St, Augusta, Georgia |
| Authorized Official Name and Position | Valerie Jean Ross (FORENSIC PSYCHOLOGIST) |
| Authorized Official Contact | 7068235250 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
639 13th St Augusta GA 30901-1007 Ph: (706) 823-5250 | 639 13th St Augusta GA 30901-1007 Ph: (706) 823-5250 |
| NPI Number | 1487059580 |
|---|---|
| Provider Enumeration Date | 10/31/2014 |
| Last Update Date | 10/31/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487059580 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TF0200X | Psychologist - Forensic | PSY002742 (Georgia) | Primary |
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