Organization
DECATUR PSYCHOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN RACKLEY LUCY PHD (OWNER)
(404) 513-6077
Entity
Organization
Contact information
Practice address
101 BIRCH ST, DECATUR, GA 30030-3340
(404) 513-6077
(404) 478-6823
Mailing address
101 BIRCH ST, DECATUR, GA 30030-3340
(404) 513-6077
(404) 478-6823
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY001911
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134380322
INDIVIDUAL NPI
GA
Enumeration date
07/13/2011
Last updated
05/26/2021
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