Organization Name: | CENTER FOR COGNITIVE REHABILITATION |
NPI Number: | 1003957879 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAGE G. WARE (OFFICE MANAGER) |
Mailing Address: | 1276 Mcconnell Dr Suite C Decatur |
State: | GA US |
Postal Code: | 300333506 |
Phone Number: | 4043211441 |
Fax Number: | 4043215876 |
NPI Enumeration Date: | 02/12/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | PSY000615 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |