Provider Demographics
NPI:1922286731
Name:PSYCHOLOGICAL SERVICES OF ATLANTA, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES OF ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-452-5353
Mailing Address - Street 1:1770 OLD SPRING HOUSE LN
Mailing Address - Street 2:SUITE #114
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6213
Mailing Address - Country:US
Mailing Address - Phone:770-452-5353
Mailing Address - Fax:770-452-5363
Practice Address - Street 1:1770 OLD SPRING HOUSE LN
Practice Address - Street 2:SUITE #114
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6213
Practice Address - Country:US
Practice Address - Phone:770-452-5353
Practice Address - Fax:770-452-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002970103TC0700X, 103TC2200X, 103TF0000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty