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Individual

DR. JASON A ANDERSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSY.D

Contact information

Practice address
120 E TRINITY PL, DECATUR, GA 30030-3302
(404) 668-3766
Mailing address
120 E TRINITY PL, DECATUR, GA 30030-3302
(404) 668-3766

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
3325
GA
103TC2200X
Clinical Child & Adolescent Psychologist
3325
GA
103TF0000X
Family Psychologist
Primary
3325
GA

Other

Enumeration date
10/26/2009
Last updated
10/26/2009
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