Provider Demographics
NPI:1932430196
Name:MARIA C. SANTANA,LLC
Entity Type:Organization
Organization Name:MARIA C. SANTANA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-925-7898
Mailing Address - Street 1:3315 FRANCINE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:404-428-6084
Mailing Address - Fax:770-925-7873
Practice Address - Street 1:5440 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047
Practice Address - Country:US
Practice Address - Phone:770-925-7898
Practice Address - Fax:770-925-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003121103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA678580757DMedicaid