| Psychological Diagnostic Center, Llc | |
|
3860 Windermere Pkwy Unit 203 Cumming GA 30041-7005 | |
| (770) 953-4744 | |
| (770) 953-4640 |
| Full Name | Psychological Diagnostic Center, Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 3860 Windermere Pkwy, Cumming, Georgia |
| Authorized Official Name and Position | Willa L Boston (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 7709534744 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Diagnostic Center, Llc 1827 Powers Ferry Rd Building 22, Suite 200 Atlanta GA 30339 Ph: (770) 953-4744 | Psychological Diagnostic Center, Llc 3860 Windermere Pkwy Unit 203 Cumming GA 30041-7005 Ph: (770) 953-4744 |
| NPI Number | 1427405554 |
|---|---|
| Provider Enumeration Date | 05/18/2016 |
| Last Update Date | 05/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427405554 | NPI | - | NPPES |
| 003169841A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY003953 (Georgia) | Primary |
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