Provider Demographics
NPI:1578686473
Name:BOUCCHECHTER, SARA (PH,D)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:BOUCCHECHTER
Suffix:
Gender:F
Credentials:PH,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CREST VALLEY DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4528
Mailing Address - Country:US
Mailing Address - Phone:770-399-5526
Mailing Address - Fax:404-257-1072
Practice Address - Street 1:1050 CROWN POINTE PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7707
Practice Address - Country:US
Practice Address - Phone:770-399-5526
Practice Address - Fax:404-257-1072
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1909103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical