Organization
THE FAMILY CENTER OF GEORGIA, INC.
Active
Organization
THE FAMILY CENTER OF GEORGIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HALISI EDWARDS STATEN PSYD (LICENSED PSYCHOLOGIST)
(678) 768-1214
Entity
Organization
Contact information
Practice address
2520 HOLLINGSWORTH ST, LITHONIA, GA 30058-4424
(770) 484-8834
Mailing address
6964 HARBOR TOWN WAY, STONE MOUNTAIN, GA 30087-5467
(770) 484-8834
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C0067
GA
103TC0700X
Clinical Psychologist
Primary
PSY002858
GA
103TF0000X
Family Psychologist
PSY002858
GA
103TP2701X
Group Psychotherapy Psychologist
PSY002858
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86355324D
—
GA
Enumeration date
09/01/2009
Last updated
09/01/2009
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