| Organization Name: | NORTHEAST GEORGIA PSYCHOLOGICAL SERVICES LLC |
| NPI Number: | 1407230410 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HEATHER FUTRAL (LICENSED PSYCHOLOGIST) |
| Mailing Address: | 4073 Highway 53 Hoschton |
| State: | GA US |
| Postal Code: | 305482305 |
| Phone Number: | 7708825884 |
| Fax Number: | |
| NPI Enumeration Date: | 07/20/2015 |
| NPI Last Update Date: | 10/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY003418 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |