Provider Demographics
NPI:1700070406
Name:SANTANA, MARIA CARMEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CARMEN
Last Name:SANTANA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 FRANCINE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3321
Mailing Address - Country:US
Mailing Address - Phone:404-428-6084
Mailing Address - Fax:
Practice Address - Street 1:700 BEAVER RUIN RD NW STE F
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3406
Practice Address - Country:US
Practice Address - Phone:770-925-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003121103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist