NPIMap

Organization Active NPI

Psychological Diagnostic Center, LLC

  • Clinical Psychologist
  • Atlanta, GA
National Provider Identifier
1184070575
Registry record updated May 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY003953 Issued in GA
Legal business name
PSYCHOLOGICAL DIAGNOSTIC CENTER, LLC
Practice address
1827 Powers Ferry Rd SE
Building 22, Suite 200
Atlanta, GA 30339-5621
Phone
(770) 953-4744
Fax
(770) 953-4640
NPI assigned
May 4, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Willa L Boston, PSY.D.
Title
Licensed Psychologist
Phone
(770) 953-4744

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PSY003953 GA Primary

Addresses

Primary practice location

1827 Powers Ferry Rd SE
Building 22, Suite 200
Atlanta, GA 30339-5621

Mailing address

1827 Powers Ferry Rd SE
Building 22, Suite 200
Atlanta, GA 30339-5621
Phone (770) 953-4744

Other identifiers 1

IdentifierTypeStateIssuer
003169841AMedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462320000000",
    "number": "1184070575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1827 POWERS FERRY RD SE",
            "address_2": "BUILDING 22, SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395621",
            "telephone_number": "770-953-4744",
            "fax_number": "770-953-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1827 POWERS FERRY RD SE",
            "address_2": "BUILDING 22, SUITE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395621",
            "telephone_number": "770-953-4744",
            "fax_number": "770-953-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL DIAGNOSTIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-04",
        "last_updated": "2016-05-04",
        "status": "A",
        "authorized_official_last_name": "BOSTON",
        "authorized_official_first_name": "WILLA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "770-953-4744",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003169841A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.