Organization
PSYCHOGENESIS, INC.
Active
Organization
PSYCHOGENESIS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUDITH TUTIN PH.D. (PRESIDENT)
(706) 232-5544
Entity
Organization
Contact information
Practice address
519 BROAD ST, SUITE 202, ROME, GA 30161-1734
(706) 232-5544
(888) 543-1173
Mailing address
2 WINDSOR RD SW, ROME, GA 30165-8555
(706) 232-5544
(888) 543-1173
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2075
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000728923A
—
GA
Enumeration date
12/24/2006
Last updated
12/03/2015
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