Organization
MADE FOR KIDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN MICHENER PH.D. (CLINICAL PSYCHOLOGIST/CO-OWNER)
(706) 995-3160
Entity
Organization
Contact information
Practice address
182 BEN BURTON CIR, SUITE 100, BOGART, GA 30622-6847
(706) 995-3160
(706) 243-4611
Mailing address
182 BEN BURTON CIR, SUITE 100, BOGART, GA 30622-6847
(706) 995-3160
(706) 243-4611
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PSY002990
GA
103TC0700X
Clinical Psychologist
PSY003136
GA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY002990
GA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY003136
GA
Other
Enumeration date
04/01/2009
Last updated
04/01/2009
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