Provider Demographics
NPI:1982377206
Name:UNITED PSYCHOLOGY CENTER, LLC
Entity Type:Organization
Organization Name:UNITED PSYCHOLOGY CENTER, LLC
Other - Org Name:NORTHEAST GEORGIA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-939-1288
Mailing Address - Street 1:2900 CHAMBLEE TUCKER RD BLDG 16
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4148
Mailing Address - Country:US
Mailing Address - Phone:770-939-1288
Mailing Address - Fax:
Practice Address - Street 1:166 COMMERCE PKWY UNIT A
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-5473
Practice Address - Country:US
Practice Address - Phone:404-806-4524
Practice Address - Fax:770-212-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty