Provider Demographics
NPI:1881924892
Name:LGD PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:LGD PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:DENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-469-6794
Mailing Address - Street 1:5438 REDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5758
Mailing Address - Country:US
Mailing Address - Phone:770-469-6794
Mailing Address - Fax:770-469-6794
Practice Address - Street 1:5438 REDWOOD CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5758
Practice Address - Country:US
Practice Address - Phone:770-469-6794
Practice Address - Fax:770-469-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW002671311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home