Organization
FAMILY PSYCHOLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY BOLES MCKAY (MANAGER)
(706) 845-1601
Entity
Organization
Contact information
Practice address
516 RIDLEY AVE, LAGRANGE, GA 30240-2234
(706) 845-1601
(706) 845-8510
Mailing address
516 RIDLEY AVE, LAGRANGE, GA 30240-2234
(706) 845-1601
(706) 845-8510
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY002670
GA
103TC0700X
Clinical Psychologist
Primary
PSY002848
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281868610A
—
GA
05
—
688606375A
—
GA
Enumeration date
12/04/2008
Last updated
12/04/2008
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