| Peachtree Psychology | |
|
555 Sun Valley Dr P4 Roswell GA 30076-5612 | |
| (678) 381-1687 | |
| Not Available |
| Full Name | Peachtree Psychology |
|---|---|
| Speciality | Counselor |
| Location | 555 Sun Valley Dr, Roswell, Georgia |
| Authorized Official Name and Position | Susan Keenan (LPC) |
| Authorized Official Contact | 6172063976 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peachtree Psychology 555 Sun Valley Dr P4 Roswell GA 30076-5612 Ph: (678) 381-1687 | Peachtree Psychology 555 Sun Valley Dr P4 Roswell GA 30076-5612 Ph: (678) 381-1687 |
| NPI Number | 1467805747 |
|---|---|
| Provider Enumeration Date | 07/21/2016 |
| Last Update Date | 07/21/2016 |
| Medicare PECOS PAC ID | 4789949504 |
|---|---|
| Medicare Enrollment ID | O20180529001441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467805747 | NPI | - | NPPES |
| 003161 | Other | GA | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 003161 (Georgia) | Primary |
| Provider Name | Lynn J Lane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104183847 PECOS PAC ID: 3971767815 Enrollment ID: I20120606000068 |
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