Child and Family Psychotherapy Center

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY001432 Issued in GA

Legal business name

CHILD AND FAMILY PSYCHOTHERAPY CENTER

Practice address

680 Douthit Ferry Rd
Suite 106
Cartersville, GA 30120-4150

Phone

(770) 334-8461

Fax

(770) 334-8624

NPI assigned

Apr 13, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Mary B Summerville, PHDNPI 1508946195

Title

Licensed Psychologist

Phone

(770) 334-8461

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Mary Beth Summerville, PH.D.

  • Clinical Psychologist
  • Town and Country, MO
  • NPI 1508946195
  NPD (past) Authorized official

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

{
    "created_epoch": "1334275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334275200000",
    "number": "1356608459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 DOUTHIT FERRY RD",
            "address_2": "SUITE 106",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301204150",
            "telephone_number": "770-334-8461",
            "fax_number": "770-334-8624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 DOUTHIT FERRY RD",
            "address_2": "SUITE 106",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301204150",
            "telephone_number": "770-334-8461",
            "fax_number": "770-334-8624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD AND FAMILY PSYCHOTHERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-13",
        "last_updated": "2012-04-13",
        "status": "A",
        "authorized_official_last_name": "SUMMERVILLE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "770-334-8461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY001432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000462294D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aneese F Chaudhry, MD
• Jigar Jayesh Chauhan, MD
• Amanda Chenault
• Megan Sanford Cherry, FNP-C
• Harry Michael Cheves, LPC
• Children'S Dental Center PC
• Children'S Dental Center, PC
• Children'S Dental Center, PC
• Amy Chiu, O.D.
• Evelyn Chiwandire, PHARMACIST

• Psychologist in Cartersville, GA
• Providers in Cartersville, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2012; 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.