Provider Demographics
NPI:1962576314
Name:CHILD & ADOLESCENT RESOURCE, P.C.
Entity type:Organization
Organization Name:CHILD & ADOLESCENT RESOURCE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DIEDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-342-3130
Mailing Address - Street 1:1200 CONFEDERATE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-2252
Mailing Address - Country:US
Mailing Address - Phone:706-342-3130
Mailing Address - Fax:
Practice Address - Street 1:1200 CONFEDERATE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2252
Practice Address - Country:US
Practice Address - Phone:706-342-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1935103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty