Provider Demographics
NPI:1821127119
Name:PEDIATRIC & FAMILY PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC & FAMILY PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KINDELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHOFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-650-4443
Mailing Address - Street 1:580 W CROSSVILLE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2506
Mailing Address - Country:US
Mailing Address - Phone:770-650-4443
Mailing Address - Fax:770-643-4854
Practice Address - Street 1:580 W CROSSVILLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2506
Practice Address - Country:US
Practice Address - Phone:770-650-4443
Practice Address - Fax:770-643-4854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty