Provider Demographics
NPI:1700190600
Name:ACADEMY PSYCHOLOGICAL SERVICES,INC
Entity Type:Organization
Organization Name:ACADEMY PSYCHOLOGICAL SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSY
Authorized Official - Phone:404-558-9830
Mailing Address - Street 1:5165 LAVISTA RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-3602
Mailing Address - Country:US
Mailing Address - Phone:404-558-9830
Mailing Address - Fax:770-939-6781
Practice Address - Street 1:5165 LAVISTA RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-3602
Practice Address - Country:US
Practice Address - Phone:404-558-9830
Practice Address - Fax:770-939-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001764103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000584526AMedicaid