| Southeastern Psychological Associates, Inc | |
|
3155 Mill Street Covington GA 30014 | |
| (404) 226-0939 | |
| (678) 802-0939 |
| Full Name | Southeastern Psychological Associates, Inc |
|---|---|
| Speciality | Psychologist |
| Location | 3155 Mill Street, Covington, Georgia |
| Authorized Official Name and Position | Priscilla Faulkner (OWNER/DIRECTOR) |
| Authorized Official Contact | 6787126520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Psychological Associates, Inc 3155 Mill Street Covington GA 30014-2542 Ph: (678) 712-6520 | Southeastern Psychological Associates, Inc 3155 Mill Street Covington GA 30014 Ph: (404) 226-0939 |
| NPI Number | 1316216880 |
|---|---|
| Provider Enumeration Date | 12/29/2011 |
| Last Update Date | 05/03/2017 |
| Medicare PECOS PAC ID | 9537320254 |
|---|---|
| Medicare Enrollment ID | O20120405000302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316216880 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | PSY002144 (Georgia) | Primary |
| Provider Name | Priscilla Faulkner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366579773 PECOS PAC ID: 0840397014 Enrollment ID: I20120502000735 |
| Provider Name | Stacia Schmidt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821519174 PECOS PAC ID: 1254696032 Enrollment ID: I20180525001997 |
| Provider Name | Matthew S Henderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184150666 PECOS PAC ID: 3577828094 Enrollment ID: I20180601002460 |
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