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Organization
PEACHTREE PSYCHOLOGY
Active
Organization
PEACHTREE PSYCHOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN KEENAN (LPC)
(617) 206-3976
Entity
Organization
Contact information
Practice address
555 SUN VALLEY DR, P4, ROSWELL, GA 30076-5612
(678) 381-1687
Mailing address
555 SUN VALLEY DR, P4, ROSWELL, GA 30076-5612
(678) 381-1687
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
003161
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003161
LICENSE
GA
Enumeration date
07/21/2016
Last updated
07/21/2016
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