Provider Demographics
NPI:1194437830
Name:COREHEALTHPSYCH
Entity type:Organization
Organization Name:COREHEALTHPSYCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-932-7654
Mailing Address - Street 1:2131 KINGSTON CT SE STE 112
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8929
Mailing Address - Country:US
Mailing Address - Phone:866-932-7654
Mailing Address - Fax:
Practice Address - Street 1:4811 BAYONNE AVE APT A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-7624
Practice Address - Country:US
Practice Address - Phone:866-932-7654
Practice Address - Fax:470-826-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty