Organization
PAVILION PSYCHOLOGICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY BAKER PSYD (OWNER)
(770) 668-4248
Entity
Organization
Contact information
Practice address
1445 HAW CREEK CORNERS CIRCLE EAST, SUITE 501, CUMMING, GA 30041
(770) 668-4248
Mailing address
PO BOX 4551, SUWANEE, GA 30024-9004
(770) 668-4248
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY003511
GA
Other
Enumeration date
03/31/2016
Last updated
03/31/2016
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