Provider Demographics
NPI:1124038542
Name:TOUCHSTONE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:TOUCHSTONE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-996-7622
Mailing Address - Street 1:1897 GODBY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5235
Mailing Address - Country:US
Mailing Address - Phone:770-996-7622
Mailing Address - Fax:770-996-5469
Practice Address - Street 1:1897 GODBY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5235
Practice Address - Country:US
Practice Address - Phone:770-996-7622
Practice Address - Fax:770-996-5469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001267103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000431395AMedicaid