Provider Demographics
NPI:1639442841
Name:PSYCARE, LLC
Entity Type:Organization
Organization Name:PSYCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINARI
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-630-0716
Mailing Address - Street 1:3270 AMHURST DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-5949
Mailing Address - Country:US
Mailing Address - Phone:216-630-0716
Mailing Address - Fax:404-758-3497
Practice Address - Street 1:807 N TENNESSEE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2895
Practice Address - Country:US
Practice Address - Phone:678-632-5787
Practice Address - Fax:404-758-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056712261QD1600X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health