LIFESPAN PSYCHOLOGY, P.C. (NPI# 1003205741) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003205741 |
| Entity Type | Organization |
| Organization Name | LIFESPAN PSYCHOLOGY, P.C. |
| Practice Address |
98 Voorhees Rd E Hamilton GA 31811-5671 |
| Practice Telephone | 9542600361 |
| Mailing Telephone | 7065823647 |
| Enumeration Date | 2015-01-19 |
| Last Update Date | 2015-01-22 |
| Authorized Official Name | DR. KEVIN JAMES WEIS (CHAIRMAN) |
| Authorized Official Telephone | 9542600361 |
| Authorized Official Credential | PSY.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103G00000X | Clinical Neuropsychologist | PSY003141 | GA | Behavioral Health & Social Service Providers |
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
PSY003142 | GA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 313423941A | 05 | |
| GA | 712348695A | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | LIFESPAN PSYCHOLOGY, PLLC | 2 5th Ave Apt 12b, New York, New York 10011-8839 |
| Street Address |
98 VOORHEES RD E |
| City | HAMILTON |
| State | GA |
| Zip Code | 31811-5671 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376738781 | Mental Retardation Wavier Program | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 9993 Ga Highway 116, Hamilton, GA 31811 | 2007-09-10 |
| 1083788640 | Harris County Board of Education | Speech-Language Pathologist | 132 Barnes Mill Road, Hamilton, GA 31811 | 2006-11-17 |
| 1881780799 | Harris County Commissioner of Roads & Revenues | Ambulance | 9907 Hwy 116, Hamilton, GA 31811 | 2006-10-05 |
| 1992732093 | Harris County Board of Health | Public Health or Welfare | 210 Foresthill Drive, Hamilton, GA 31811 | 2006-06-26 |
| 1073770046 | Alan Bennett Miller | Emergency Medicine | 153 S College St, Hamilton, GA 31811 | 2008-05-19 |
| 1609952589 | George Alexander Garrett | Optometrist | 121 Dogwood Lane, Hamilton, GA 31811-0589 | 2006-10-31 |
| 1174892442 | Roger Leon O'bryan | Family Medicine | 1792 Quail Hollow Dr, Hamilton, GA 31811-3411 | 2011-12-15 |
| 1336269208 | William Wilson | Ophthalmology | 415 Lakewood Dr, Hamilton, GA 31811-3636 | 2007-04-02 |
| 1447368238 | Michael Scott | Radiology | 180 Old House Rd, Hamilton, GA 31811-4018 | 2006-08-29 |
| 1043583339 | Tomekia Yolanda Hinton | Licensed Practical Nurse | 139 Maddox Rd, Hamilton, GA 31811-4314 | 2012-02-16 |
| Find all providers in zip 31811 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871766931 | Katherine Heffernan | Psychologist | 2250 Pleasant Ave, Hamilton, OH 45015-1135 | 2008-04-10 |
| 1598938656 | Eckart Wallisch | Psychologist | 2100 Plesant Avenue, Hamilton, OH 45015 | 2008-04-10 |
| 1982757076 | James D Fuhrman | Psychologist | 36 Orchard Dr, Hamilton, OH 45013-3454 | 2007-01-19 |
| 1699934950 | Charles R Lee | Psychologist | 2100 Pleasant Avenue, Hamilton, OH 45015 | 2008-06-03 |
| 1821261751 | Katherine Mcree Lauch | Psychologist | 2100 Pleasant Avenue, Hamilton, OH 45015 | 2008-04-11 |
| 1952574014 | Anita Leshner | Psychologist | 2100 Pleasant Avenue, Hamilton, OH 45015 | 2008-04-10 |
| 1689847949 | Lara Stone | Psychologist | 2100 Pleasant Avenue, Hamilton, OH 45015 | 2008-04-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538693254 | Rachel Yosick | Psychologist | 520 Wembley Cir, Sandy Springs, GA 30328-6753 | 2017-04-19 |
| 1174974620 | Warren Umansky, Ph.d. | Psychologist | 302 Wheeler Executive Ctr, Augusta, GA 30909 | 2016-06-27 |
| 1245655893 | Tiffany Gilmore Randell | Psychologist | 101 Devant Street, Office 401, Fayetteville, GA 30214 | 2014-02-19 |
| 1972927861 | Tyrone D. Lane Enterprises, Incorporated | Psychologist | 5304 Panola Industrial Boulevard, Suite L, Decatur, GA 30035 | 2014-02-12 |
| 1720409493 | Tonya Favors | Psychologist | 311 S Lee St, Apt C, Americus, GA 31709-3971 | 2013-12-26 |
| 1912336546 | Francine Adams | Psychologist | 324 Trace Ln, Lawrenceville, GA 30046-2896 | 2013-11-04 |
| 1447542691 | Erin Marie Jones | Psychologist | 1256 Briarcliff Rd Ne Ste 322e, Atlanta, GA 30306-2636 | 2011-05-06 |
| 1164729901 | Tiffany Whitworth | Psychologist | 4139 Hospital Dr Ne, Covington, GA 30014-2565 | 2011-02-14 |
| 1548573264 | Kimberley Blaker Saye | Psychologist | 4695 Mahonia Way Nw, Acworth, GA 30102-3575 | 2010-07-22 |
| 1316269350 | Caitlin Herzinger Delfs | Psychologist | 4994 Lower Roswell Rd Ste 10, Marietta, GA 30068-4332 | 2010-02-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.