Provider Demographics
NPI:1922266014
Name:SOUTHERN PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:SOUTHERN PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHENK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:229-228-1950
Mailing Address - Street 1:PO BOX 1403
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-1403
Mailing Address - Country:US
Mailing Address - Phone:229-228-1950
Mailing Address - Fax:229-228-1978
Practice Address - Street 1:1213 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4748
Practice Address - Country:US
Practice Address - Phone:229-228-1950
Practice Address - Fax:229-228-1978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2406103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty