Provider Demographics
NPI:1427571322
Name:CENTER FOR PSYCHOLOGICAL DISCOVERY PC KATRINA L LOKKEN
Entity Type:Organization
Organization Name:CENTER FOR PSYCHOLOGICAL DISCOVERY PC KATRINA L LOKKEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOKKEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:678-820-8386
Mailing Address - Street 1:286 S MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1943
Mailing Address - Country:US
Mailing Address - Phone:678-820-8386
Mailing Address - Fax:770-234-5889
Practice Address - Street 1:286 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1943
Practice Address - Country:US
Practice Address - Phone:678-820-8386
Practice Address - Fax:770-234-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 103TC0700X, 103TC2200X
GAPSY003288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA495932390IMedicaid