Individual
DR. THEODORE ALEXANDER DANIEL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST/PSY.D
Contact information
Practice address
1287 MARKS CHURCH RD, SUITE F, AUGUSTA, GA 30909-6330
(706) 481-8181
(706) 650-8427
Mailing address
2807 SPRINGWOOD DR, AUGUSTA, GA 30909-2332
(706) 738-3621
(706) 738-3621
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1662
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00546433A
—
GA
Enumeration date
05/10/2006
Last updated
07/08/2007
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