Organization
THE FERN CENTER FOR LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA GRANGE PHD (CEO)
(404) 694-4205
Entity
Organization
Contact information
Practice address
158 MORELAND AVE SE, ATLANTA, GA 30316-1676
(404) 694-4205
(877) 759-8014
Mailing address
1624 NEWTON AVE SE, ATLANTA, GA 30316-2116
(404) 694-4205
(877) 759-8014
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003766
LICENSE
GA
Enumeration date
06/04/2019
Last updated
06/04/2019
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