Samudra Psychological Services LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

003691 Issued in GA

Legal business name

SAMUDRA PSYCHOLOGICAL SERVICES LLC

Practice address

675 Seminole Ave NE Ste T03
Atlanta, GA 30307-3409

Phone

(404) 249-0520

NPI assigned

Jul 24, 2018

Last updated

Jul 24, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Elizabeth Sue Bradshaw-Livingston, PHDNPI 1962989780

Title

Licensed Psychologist

Phone

(404) 249-0520

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elizabeth Sue Bradshaw-Livingston, PHD

  • Psychologist
  • Atlanta, GA
  • NPI 1962989780
  NPD (past) Authorized official
• Dawn Kitto, MS, LPC

  • Mental Health Counselor
  • Atlanta, GA
  • NPI 1063814713
  NPD (past)

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

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532390400000",
    "number": "1194202911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 SOMERLANE PL",
            "city": "AVONDALE ESTATES",
            "state": "GA",
            "postal_code": "300021221",
            "telephone_number": "269-352-7407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 SEMINOLE AVE NE STE T03",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303073409",
            "telephone_number": "404-249-0520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUDRA PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-24",
        "last_updated": "2018-07-24",
        "status": "A",
        "authorized_official_last_name": "BRADSHAW-LIVINGSTON",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "404-249-0520",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": "003691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Sams, MD
• Octavis Sams
• Ralph Newton Sams, MD
• Shabnam Samsuddin, CRNA
• Radha Samtani, NP
• Samuel B. Elliott (Speech Services For Children)
• Amanda Samuel
• Angela Maria Samuel, DNP
• Brittinae Samuel
• Helen R Samuel, RN

• Mental Health Clinic/Center (Including Community Mental Health Center) in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; 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.