| The Psychology Center | |
|
6130 Prestley Mill Rd Ste A Douglasville GA 30134-2288 | |
| (770) 949-9675 | |
| (770) 949-9676 |
| Full Name | The Psychology Center |
|---|---|
| Speciality | Psychologist |
| Location | 6130 Prestley Mill Rd Ste A, Douglasville, Georgia |
| Authorized Official Name and Position | Dennis Lloyd Herendeen (OWNER) |
| Authorized Official Contact | 7709499675 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Psychology Center 6130 Prestley Mill Rd Ste A Douglasville GA 30134-2288 Ph: (770) 949-9675 | The Psychology Center 6130 Prestley Mill Rd Ste A Douglasville GA 30134-2288 Ph: (770) 949-9675 |
| NPI Number | 1336363928 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0244402154 |
|---|---|
| Medicare Enrollment ID | O20111018000412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336363928 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY000444 (Georgia) | Primary |
| Provider Name | Dennis L Herendeen |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1629039813 PECOS PAC ID: 6800068818 Enrollment ID: I20111018000384 |
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