Organization
BALANCE & POTENTIAL INC
Active
Organization
BALANCE & POTENTIAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIRSTEN MOORE PSY.D. (PRESIDENT)
(678) 644-0039
Entity
Organization
Contact information
Practice address
555 SUN VALLEY DR STE P4, ROSWELL, GA 30076-5633
(678) 644-0039
(678) 669-2740
Mailing address
555 SUN VALLEY DR STE P4, ROSWELL, GA 30076-5633
(678) 644-0039
(678) 669-2740
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY003755
GA
103TB0200X
Cognitive & Behavioral Psychologist
PSY003755
GA
103TC0700X
Clinical Psychologist
Primary
PSY003755
GA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY003755
GA
103TP2701X
Group Psychotherapy Psychologist
PSY003755
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003148513A
—
GA
Enumeration date
03/04/2015
Last updated
03/04/2015
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