Organization Name: | POWELL PSYCHOLOGICAL ASSOCIATES |
NPI Number: | 1003169145 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES POWELL (OWNER) |
Mailing Address: | 2501 E Piedmont Rd Suite 200, Pmb 5 Marietta |
State: | GA US |
Postal Code: | 300627752 |
Phone Number: | 4044036177 |
Fax Number: | 4043936460 |
NPI Enumeration Date: | 10/25/2012 |
NPI Last Update Date: | 10/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY002212 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |