Provider Demographics
NPI:1710039839
Name:CANDLER PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:CANDLER PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DAUGHTRY
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:912-685-6259
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:66 NORTH ROUNTREE STREET
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-1146
Mailing Address - Country:US
Mailing Address - Phone:912-685-6259
Mailing Address - Fax:912-685-9871
Practice Address - Street 1:66 N ROUNTREE ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-4019
Practice Address - Country:US
Practice Address - Phone:912-685-6259
Practice Address - Fax:912-685-9871
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
GA001780103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00529119BMedicaid