Organization
LIVING FULLY PSYCHOLOGICAL SERVICES, LLC
Active
Other names
Pegah Moghaddam, Psy.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PEGAH MOGHADDAM PSY.D. (DIRECTOR)
(678) 591-9117
Entity
Organization
Contact information
Practice address
111 N MCDONOUGH ST, DECATUR, GA 30030-3317
(678) 591-9117
(770) 458-8640
Mailing address
111 N MCDONOUGH ST, DECATUR, GA 30030-3317
(678) 591-9117
(770) 458-8640
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY003405
GA
Other
Enumeration date
05/17/2012
Last updated
03/04/2013
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