Provider Demographics
NPI:1760999767
Name:ALESYA KOREY
Entity Type:Organization
Organization Name:ALESYA KOREY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALESYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-862-8106
Mailing Address - Street 1:540 POWDER SPRINGS ST STE E31
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3563
Mailing Address - Country:US
Mailing Address - Phone:404-862-8106
Mailing Address - Fax:
Practice Address - Street 1:540 POWDER SPRINGS ST STE E31
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3563
Practice Address - Country:US
Practice Address - Phone:404-862-8106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY3835103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003191658AMedicaid