Provider Demographics
NPI:1679692180
Name:DR. PATRICIA FARLEY, PHD, LLC
Entity Type:Organization
Organization Name:DR. PATRICIA FARLEY, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-298-1000
Mailing Address - Street 1:2330 SCENIC HWY S
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3115
Mailing Address - Country:US
Mailing Address - Phone:770-298-1000
Mailing Address - Fax:866-298-1001
Practice Address - Street 1:1770 INDIAN TRAIL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2645
Practice Address - Country:US
Practice Address - Phone:727-560-8400
Practice Address - Fax:678-287-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2417103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00872429DMedicaid
GA00872429CMedicaid
FLD2797AAD9DOtherTRICARE
GA68BBGCMMedicare ID - Type Unspecified
GA00872429CMedicaid