Provider Demographics
NPI:1417281619
Name:PSYCHOLOGY AND COUNSELING CENTERS PC
Entity Type:Organization
Organization Name:PSYCHOLOGY AND COUNSELING CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-386-8996
Mailing Address - Street 1:17 FELTON PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2153
Mailing Address - Country:US
Mailing Address - Phone:770-386-8996
Mailing Address - Fax:770-386-8100
Practice Address - Street 1:17 FELTON PL
Practice Address - Street 2:SUITE A
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2153
Practice Address - Country:US
Practice Address - Phone:770-386-8996
Practice Address - Fax:770-386-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001063103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000418371FMedicaid
GA000418371FMedicaid