NPIMap

Organization Active NPI

Soublis Psychological Associates, LLC

  • Clinical Psychologist
  • Roswell, GA
National Provider Identifier
1336094234
Registry record updated Mar 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SOUBLIS PSYCHOLOGICAL ASSOCIATES, LLC
Practice address
1003 Bombay LN
Roswell, GA 30076-5820
Phone
(678) 782-2560
Fax
(678) 782-2560
NPI assigned
Mar 4, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2026

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

Authorized official

Name
Theodora Soublis, PHDNPI 1962672261
Title
Director
Phone
(770) 362-4815

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X

Addresses

Primary practice location

1003 Bombay LN
Roswell, GA 30076-5820

Mailing address

1003 Bombay LN
Roswell, GA 30076-5820
Phone (678) 782-2560

Other names 1

  • Theodora Soublis, PHD Former legal business name

National Provider Directory

National Provider Directory

Locations

1003 Bombay Ln
Roswell, GA 30076
Phone (678) 782-2560

Practitioners & affiliated clinicians

Practitioners 3

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": "1772582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772582400000",
    "number": "1336094234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 BOMBAY LN",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765820",
            "telephone_number": "678-782-2560",
            "fax_number": "678-782-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 BOMBAY LN",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765820",
            "telephone_number": "678-782-2560",
            "fax_number": "678-782-2560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUBLIS PSYCHOLOGICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-04",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A",
        "authorized_official_last_name": "SOUBLIS",
        "authorized_official_first_name": "THEODORA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "770-362-4815",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Theodora Soublis, PHD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; 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.