Provider Demographics
NPI:1306072954
Name:METRO ATLANTA PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:METRO ATLANTA PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:WASSERMAN
Authorized Official - Last Name:LOEB
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:770-417-2732
Mailing Address - Street 1:5825 GLENRIDGE DR NE
Mailing Address - Street 2:BLDG. 2, ST.E. 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5387
Mailing Address - Country:US
Mailing Address - Phone:404-303-1935
Mailing Address - Fax:404-303-8488
Practice Address - Street 1:5825 GLENRIDGE DR NE
Practice Address - Street 2:BLDG. 2, ST.E. 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:404-303-1935
Practice Address - Fax:404-303-8488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001688101YP2500X
GALPC003775101YP2500X
GALPC002966101YP2500X
GACSW0016241041C0700X
GAPSY002865103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty