| NPI | 1912115114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL KELLI LACY President, Licensed Psychologist 770-722-7827 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA PSY002801) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: GA PSY002801) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: GA PSY002801) | |
| 103TC0700X Psychologist, Clinical (Licence: GA PSY002801) | |
| 103TF0200X Psychologist, Forensic (Licence: GA PSY002801) | |
| 103TH0004X Psychologist, Health (Licence: GA PSY002801) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: GA PSY002801) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: GA PSY002801) | |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2018-10-29 |