Provider Demographics
NPI:1326013855
Name:SNOOK, STEVEN CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHARLES
Last Name:SNOOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DEVANT ST STE 1001
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2719
Mailing Address - Country:US
Mailing Address - Phone:770-997-1738
Mailing Address - Fax:678-545-6173
Practice Address - Street 1:101 DEVANT ST STE 1001
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2719
Practice Address - Country:US
Practice Address - Phone:770-997-1738
Practice Address - Fax:678-545-6173
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY0001477103T00000X, 103TB0200X, 103TC2200X
GA1477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000545201AMedicaid
GA000545201AMedicaid