Organization
SUPPORTIVE CARE OF GEORGIA LLC
Active
Organization
SUPPORTIVE CARE OF GEORGIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAPHAEL LICHTSCHEIN (PRESIDENT)
(718) 298-4375
Entity
Organization
Contact information
Practice address
300 COLONIAL CENTER PKWY STE 100N, ROSWELL, GA 30076-4892
(718) 298-4375
Mailing address
27 RANDOLPH RD, HOWELL, NJ 07731-8611
(718) 298-4375
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
06/08/2021
Last updated
06/08/2021
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