Provider Demographics
NPI:1902958341
Name:PSYCHOTHERAPY AND ASSESSMENT SERVICES
Entity Type:Organization
Organization Name:PSYCHOTHERAPY AND ASSESSMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:770-534-9100
Mailing Address - Street 1:629 DAWSONVILLE HWY
Mailing Address - Street 2:SUITE 2201
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2610
Mailing Address - Country:US
Mailing Address - Phone:770-534-9100
Mailing Address - Fax:770-534-9104
Practice Address - Street 1:629 DAWSONVILLE HWY
Practice Address - Street 2:SUITE 2201
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2610
Practice Address - Country:US
Practice Address - Phone:770-534-9100
Practice Address - Fax:770-534-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00484514CMedicaid
GA68BBDPVMedicare ID - Type Unspecified