Organization
PSYCHOLOGICAL DIAGNOSTIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLA L BOSTON PSY.D. (LICENSED PSYCHOLOGIST)
(770) 953-4744
Entity
Organization
Contact information
Practice address
3860 WINDERMERE PKWY, UNIT 203, CUMMING, GA 30041-7005
(770) 953-4744
(770) 953-4640
Mailing address
1827 POWERS FERRY RD, BUILDING 22, SUITE 200, ATLANTA, GA 30339
(770) 953-4744
(770) 953-4640
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY003953
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003169841A
—
GA
Enumeration date
05/18/2016
Last updated
05/18/2016
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