Provider Demographics
NPI:1053650689
Name:ROY L. DIAL III, LMFT, PH.D., PC
Entity Type:Organization
Organization Name:ROY L. DIAL III, LMFT, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT PHD
Authorized Official - Phone:678-596-0773
Mailing Address - Street 1:11807 NORTHFALL LN
Mailing Address - Street 2:SUITE 901
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7977
Mailing Address - Country:US
Mailing Address - Phone:678-596-0773
Mailing Address - Fax:
Practice Address - Street 1:11807 NORTHFALL LN
Practice Address - Street 2:SUITE 901
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7977
Practice Address - Country:US
Practice Address - Phone:678-596-0773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000748106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty