Provider Demographics
NPI:1487059580
Name:NEUROBEHAVIORAL ASSOCIATES LLC
Entity type:Organization
Organization Name:NEUROBEHAVIORAL ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FORENSIC PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-823-5250
Mailing Address - Street 1:639 13TH ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1007
Mailing Address - Country:US
Mailing Address - Phone:706-823-5250
Mailing Address - Fax:706-823-5266
Practice Address - Street 1:639 13TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1007
Practice Address - Country:US
Practice Address - Phone:706-823-5250
Practice Address - Fax:706-823-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002742103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty