Organization
CHILD NEUROBEHAVIORAL CENTER FOR HEALTH & WELLNESS, PC
Active
Other names
Maria E Gangarosa-Emerson, PhD, PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIA E GANGAROSA EMERSON PHD (OWNER)
(706) 447-8700
Entity
Organization
Contact information
Practice address
302 BASTON RD, MARTINEZ, GA 30907-2906
(706) 447-8700
(706) 447-8701
Mailing address
PO BOX 2854, EVANS, GA 30809-2854
(706) 447-8700
(770) 447-8701
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103G00000X
Clinical Neuropsychologist
2381
GA
103T00000X
Psychologist
Primary
2381
GA
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000852277B
—
GA
01
—
52669312-001
BCBS
GA
Enumeration date
12/18/2006
Last updated
04/03/2014
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