Provider Demographics
NPI:1093766719
Name:INNERACTION PSYCHOLOGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:INNERACTION PSYCHOLOGICAL ASSOCIATES, P.C.
Other - Org Name:TERESSA HAEGER, PH.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESSA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-864-0186
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0009
Mailing Address - Country:US
Mailing Address - Phone:706-864-0186
Mailing Address - Fax:706-864-0963
Practice Address - Street 1:81 CROWN MOUNTAIN PL
Practice Address - Street 2:SUITE C200
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1627
Practice Address - Country:US
Practice Address - Phone:706-864-0186
Practice Address - Fax:706-864-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000680996CMedicaid
GA000680996DMedicaid
GA68BBFWCMedicare ID - Type Unspecified
GA000680996CMedicaid
GA68BBGSFMedicare ID - Type Unspecified