Organization
VIRGINIA L GOETSCH, PH.D., LLC
Active
Other names
Virginia L. Goetsch, Ph.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIRGINIA L GOETSCH PH.D. (PRESIDENT)
(770) 301-3578
Entity
Organization
Contact information
Practice address
775 COMMERCE DR, SUITE 903, DECATUR, GA 30030-2620
(770) 301-3578
(404) 638-5293
Mailing address
5282 HICKORY WALK TER SW, CONYERS, GA 30094-4757
(770) 301-3578
(404) 638-5293
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2269
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000820817C
—
GA
01
—
11511070
CAQH
GA
Enumeration date
08/31/2012
Last updated
11/01/2012
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