Provider Demographics
NPI:1346643715
Name:SAGE PSYCHOLOGICAL CONSULTING, LLC
Entity Type:Organization
Organization Name:SAGE PSYCHOLOGICAL CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRIPHINIA
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-317-2283
Mailing Address - Street 1:4556 PARKVIEW SQ
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-9408
Mailing Address - Country:US
Mailing Address - Phone:404-317-2283
Mailing Address - Fax:404-393-6692
Practice Address - Street 1:1718 PEACHTREE ST NW
Practice Address - Street 2:SUITE 481
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2452
Practice Address - Country:US
Practice Address - Phone:404-317-2283
Practice Address - Fax:404-393-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003723251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health