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Organization
LIFESPAN PSYCHOLOGY, P.C.
Active
Organization
LIFESPAN PSYCHOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN JAMES WEIS PSY.D. (CHAIRMAN)
(954) 260-0361
Entity
Organization
Contact information
Practice address
98 VOORHEES RD E, HAMILTON, GA 31811-5671
(954) 260-0361
Mailing address
98 VOORHEES RD E, HAMILTON, GA 31811-5671
(706) 582-3647
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PSY003141
GA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY003142
GA
Other
Enumeration date
01/19/2015
Last updated
01/22/2015
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