Provider Demographics
NPI:1942677513
Name:PSYCHOLOGICAL ASSESSMENT CENTER, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSESSMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-742-9102
Mailing Address - Street 1:3320 SKYWAY DR
Mailing Address - Street 2:#801
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7137
Mailing Address - Country:US
Mailing Address - Phone:334-742-9102
Mailing Address - Fax:334-742-9103
Practice Address - Street 1:3320 SKYWAY DR
Practice Address - Street 2:#801
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7137
Practice Address - Country:US
Practice Address - Phone:334-742-9102
Practice Address - Fax:334-742-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-29
Last Update Date:2015-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1041103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty