Provider Demographics
NPI:1538279641
Name:MAGUIRE & MOORE PSYCLOLOGICAL SERVICES
Entity Type:Organization
Organization Name:MAGUIRE & MOORE PSYCLOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS, LPC/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SADIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-722-7788
Mailing Address - Street 1:448 TELFAIR ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-5811
Mailing Address - Country:US
Mailing Address - Phone:706-722-7788
Mailing Address - Fax:706-724-8300
Practice Address - Street 1:448 TELFAIR ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5811
Practice Address - Country:US
Practice Address - Phone:706-722-7788
Practice Address - Fax:706-724-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 1325103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty