Organization
SWEETWATER PSYCHOLOGICAL ASSOCIATES, LLC
Active
Organization
SWEETWATER PSYCHOLOGICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID C MARTIN PH.D (OWNER PARTNER)
(770) 732-0982
Entity
Organization
Contact information
Practice address
560 THORNTON RD, SUITE 106, LITHIA SPRINGS, GA 30122-1655
(770) 732-0982
(770) 732-1283
Mailing address
PO BOX 1078, LITHIA SPRINGS, GA 30122-7078
(770) 732-0982
(770) 732-1283
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY001373, PSY001157
GA
103TB0200X
Cognitive & Behavioral Psychologist
PSY001157
GA
103TB0200X
Cognitive & Behavioral Psychologist
PSY001373
GA
103TC0700X
Clinical Psychologist
Primary
PSY001373,PSY001157
GA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY001373, PSY001157
GA
1041C0700X
Clinical Social Worker
CSW000729
GA
Other
Enumeration date
08/30/2006
Last updated
10/27/2007
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