Organization
COASTAL GEORGIA PSYCHODYNAMIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMANDA RICKARD (ORGANIZER)
(912) 421-9050
Entity
Organization
Contact information
Practice address
325 S WALNUT ST, STATESBORO, GA 30458-5418
(912) 421-9050
(912) 623-4918
Mailing address
325 S WALNUT ST, STATESBORO, GA 30458-5418
(912) 421-9050
(912) 623-4918
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY003907
GA
Other
Enumeration date
02/28/2017
Last updated
05/11/2020
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