Provider Demographics
NPI:1093048324
Name:STEVEN SNOOK, PH.D., LLC
Entity Type:Organization
Organization Name:STEVEN SNOOK, PH.D., LLC
Other - Org Name:ASSESSMENT AND COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SROKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-997-1738
Mailing Address - Street 1:1651 PHOENIX BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5552
Mailing Address - Country:US
Mailing Address - Phone:770-997-1738
Mailing Address - Fax:770-991-1375
Practice Address - Street 1:1651 PHOENIX BLVD STE 2
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5552
Practice Address - Country:US
Practice Address - Phone:770-997-1738
Practice Address - Fax:770-991-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003891101YP2500X
GALPC0006197101YP2500X
GAPSY0001477103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000545201AMedicaid
GA000545201BMedicaid