Organization
PEDIATRIC AUTISM CLINICAL & EVALUATION SERVICES LLC
Active
Other names
Pediatric Autism Clinical & Evaluation Services, LLC, P.A.C.E.S., LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE ANNE NORTHINGTON PHD (PSYCHOLOGIST/PARTNER)
(706) 842-3272
Entity
Organization
Contact information
Practice address
2945 WALTON WAY, AUGUSTA, GA 30909-3827
(706) 842-3279
(706) 842-3272
Mailing address
2945 WALTON WAY, AUGUSTA, GA 30909-3827
(706) 842-3272
(706) 842-3272
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
GA
103TC0700X
Clinical Psychologist
Primary
—
GA
106S00000X
Behavior Technician
—
GA
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386012573
OCCUPATIONAL THERAPY
GA
01
—
1457632150
PSYCHOLOGY
GA
01
—
1700123163
SPEECH THERAPY
GA
Enumeration date
07/27/2017
Last updated
07/08/2021
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