Provider Demographics
NPI:1053416495
Name:AUGUSTA PSYCHOLOGICAL ASSOCIATES
Entity type:Organization
Organization Name:AUGUSTA PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-949-4202
Mailing Address - Street 1:73 WILSON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2286
Mailing Address - Country:US
Mailing Address - Phone:540-949-4202
Mailing Address - Fax:540-949-7109
Practice Address - Street 1:73 WILSON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2286
Practice Address - Country:US
Practice Address - Phone:540-949-4202
Practice Address - Fax:540-949-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 103TC0700X, 1041C0700X
VA01010416892084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty