Provider Demographics
NPI:1578996492
Name:KATIE TART ALLEN, PSY.D., P.C.
Entity Type:Organization
Organization Name:KATIE TART ALLEN, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:TART
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:919-669-1685
Mailing Address - Street 1:604 ABINGDON WAY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1683
Mailing Address - Country:US
Mailing Address - Phone:919-669-1685
Mailing Address - Fax:
Practice Address - Street 1:2849B HENDERSON MILL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-5772
Practice Address - Country:US
Practice Address - Phone:770-939-1288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003583103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty