Provider Demographics
NPI:1376611921
Name:BETTS, THERESA (PSYD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:BETTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:BETTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1007 RIVERBEND RD SE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-4837
Mailing Address - Country:US
Mailing Address - Phone:404-403-1522
Mailing Address - Fax:404-403-1422
Practice Address - Street 1:1007 RIVERBEND RD SE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4837
Practice Address - Country:US
Practice Address - Phone:404-403-1522
Practice Address - Fax:404-403-1422
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical