| Wisteria Psychological Services Llc | |
|
235 E Ponce De Leon Ave Ste 265 Decatur GA 30030-3452 | |
| (678) 558-9428 | |
| Not Available |
| Full Name | Wisteria Psychological Services Llc |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 235 E Ponce De Leon Ave Ste 265, Decatur, Georgia |
| Authorized Official Name and Position | Nadrat Nuhu (PSYCHOLOGIST) |
| Authorized Official Contact | 6785589428 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wisteria Psychological Services Llc 1136 Mason Woods Dr Ne Atlanta GA 30329-3804 Ph: (678) 558-9428 | Wisteria Psychological Services Llc 235 E Ponce De Leon Ave Ste 265 Decatur GA 30030-3452 Ph: (678) 558-9428 |
| NPI Number | 1407683295 |
|---|---|
| Provider Enumeration Date | 09/17/2024 |
| Last Update Date | 09/17/2024 |
| Certification Date | 09/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407683295 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | (* (Not Available)) | Primary |
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