Organization
MAYO PSYCHOLOGICAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN LESLIE MAYO PH.D. (PRESIDENT)
(770) 956-9212
Entity
Organization
Contact information
Practice address
1640 POWERS FERRY RD SE, BLDG. 17, STE. 350, MARIETTA, GA 30067-5491
(770) 956-9212
(770) 956-9211
Mailing address
1640 POWERS FERRY RD SE, BLDG. 17, STE. 350, MARIETTA, GA 30067-5491
(770) 956-9212
(770) 956-9211
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1582
GA
251S00000X
Community/Behavioral Health Agency
1582
GA
Other
Enumeration date
01/26/2009
Last updated
05/28/2013
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