Provider Demographics
NPI:1376389213
Name:PEACH AND PALM WOMEN'S HEALTH PSYCHOLOGY, PC
Entity type:Organization
Organization Name:PEACH AND PALM WOMEN'S HEALTH PSYCHOLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILY
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:KADOSH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-809-6995
Mailing Address - Street 1:2090 DUNWOODY CLUB DR STE 106-196
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-5434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 VALLEY HALL DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-4631
Practice Address - Country:US
Practice Address - Phone:770-809-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist