Organization
CHILD AND FAMILY PSYCHOTHERAPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY B SUMMERVILLE PHD (LICENSED PSYCHOLOGIST)
(770) 334-8461
Entity
Organization
Contact information
Practice address
680 DOUTHIT FERRY RD, SUITE 106, CARTERSVILLE, GA 30120-4150
(770) 334-8461
(770) 334-8624
Mailing address
680 DOUTHIT FERRY RD, SUITE 106, CARTERSVILLE, GA 30120-4150
(770) 334-8461
(770) 334-8624
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY001432
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000462294D
—
GA
Enumeration date
04/13/2012
Last updated
04/13/2012
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