Organization
CORCAIR PYSCHOLOGICAL SERVICES, LLC
Active
Organization
CORCAIR PYSCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JILL C ANDERSON PSYD (OWNER)
(404) 542-5287
Entity
Organization
Contact information
Practice address
235 E PONCE DE LEON AVE, SUITE 110, DECATUR, GA 30030-3452
(404) 542-5287
(888) 485-5215
Mailing address
235 E PONCE DE LEON AVE, SUITE 110, DECATUR, GA 30030-3452
(404) 542-5287
(888) 485-5215
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY003030
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003101292A
—
GA
Enumeration date
05/14/2011
Last updated
05/14/2011
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