Provider Demographics
NPI:1679791552
Name:SANDY SPRINGS PSYCHOLOGICAL CENTER, P.C.
Entity type:Organization
Organization Name:SANDY SPRINGS PSYCHOLOGICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:DRAISIN
Authorized Official - Last Name:WOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-255-1032
Mailing Address - Street 1:6000 LAKE FORREST DR NW
Mailing Address - Street 2:SUITE 575
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3824
Mailing Address - Country:US
Mailing Address - Phone:404-255-1032
Mailing Address - Fax:404-255-3234
Practice Address - Street 1:6000 LAKE FORREST DR NW
Practice Address - Street 2:SUITE 575
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3824
Practice Address - Country:US
Practice Address - Phone:404-255-1032
Practice Address - Fax:404-255-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1019103T00000X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty