Provider Demographics
NPI:1619202918
Name:AFFILIATED PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:AFFILIATED PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:FEINSILBER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-205-5760
Mailing Address - Street 1:6030 BETHELVIEW RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8020
Mailing Address - Country:US
Mailing Address - Phone:770-205-5760
Mailing Address - Fax:770-205-5780
Practice Address - Street 1:6030 BETHELVIEW RD
Practice Address - Street 2:SUITE 401
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8020
Practice Address - Country:US
Practice Address - Phone:770-205-5760
Practice Address - Fax:770-205-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA896103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty