Provider Demographics
NPI:1174852214
Name:NORTH GEORGIA PSYCHOLOGICAL CONSULTANTS
Entity type:Organization
Organization Name:NORTH GEORGIA PSYCHOLOGICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-992-0089
Mailing Address - Street 1:11755 POINTE PL STE B
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4656
Mailing Address - Country:US
Mailing Address - Phone:678-992-0089
Mailing Address - Fax:
Practice Address - Street 1:11755 POINTE PL STE B
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4656
Practice Address - Country:US
Practice Address - Phone:678-992-0089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1522103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1522OtherLICENSED PSYCHOLOGIST
GA2282OtherLICENSED PROFESSIONAL COUNSELOR