SAMUDRA PSYCHOLOGICAL SERVICES LLC (NPI# 1194202911) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194202911 |
| Entity Type | Organization |
| Organization Name | SAMUDRA PSYCHOLOGICAL SERVICES LLC |
| Practice Address |
675 Seminole Ave Ne Ste T03 Atlanta GA 30307-3409 |
| Mailing Address |
316 Somerlane Pl Avondale Estates GA 30002-1221 |
| Practice Telephone | 4042490520 |
| Mailing Telephone | 2693527407 |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2018-07-24 |
| Authorized Official Name | DR. ELIZABETH SUE BRADSHAW-LIVINGSTON (LICENSED PSYCHOLOGIST) |
| Authorized Official Telephone | 4042490520 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
003691 | GA | Ambulatory Health Care Facilities |
| Street Address |
675 SEMINOLE AVE NE STE T03 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30307-3409 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063814713 | Dawn Kitto | Counselor | 675 Seminole Ave Ne Ste T03, Atlanta, GA 30307-3409 | 2014-09-24 |
| 1962989780 | Elizabeth Sue Bradshaw-livingston | Psychologist | 675 Seminole Ave Ne Ste T03, Atlanta, GA 30307-3409 | 2018-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033716774 | Shannon Busby Bagga | Dietitian, Registered | 1806 Dekalb Ave Ne, Atlanta, GA 30307 | 2020-10-06 |
| 1366062846 | Key Counseling Group, LLC | Social Worker | 675 Seminole Ave. Ne, Ste. 111, Atlanta, GA 30307 | 2020-04-24 |
| 1730683749 | Kristina Joy Betz | Pediatrics | 2105 Uppergate Drive, Atlanta, GA 30307 | 2018-03-23 |
| 1336658558 | Erin Asteghene | Specialist/Technologist | 1509 South Ponce De Leon Ave., Atlanta, GA 30307 | 2017-09-20 |
| 1689196446 | Sera Kim | Student in an Organized Health Care Education/Training Program | 1648 Pierce Drive Ne, Atlanta, GA 30307 | 2017-07-13 |
| 1164974168 | Megan Elizabeth Tarshis | Social Worker | 675 Seminole Ave., Suite 210, Atlanta, GA 30307 | 2016-10-26 |
| 1255703880 | Jennifer Browning Eastman | Speech-Language Pathologist | 1053 Oakdale Road, Atlanta, GA 30307 | 2015-10-22 |
| 1639566714 | Amit Shah | Student in an Organized Health Care Education/Training Program | 1648 Pierce Drive, Atlanta, GA 30307 | 2015-04-16 |
| 1134524853 | Sheryl Cababat Caberto | Internal Medicine | 1648 Pierce Dr Ne, Atlanta, GA 30307 | 2014-10-23 |
| 1942568803 | Sarah Coyle Burke | Anesthesiology | 870 Inman Village Pkwy Ne, #305, Atlanta, GA 30307 | 2012-04-30 |
| Find all providers in zip 30307 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124632013 | Dunwoody Mental Health Center | Clinic/Center | 4594 Barclay Dr, Atlanta, GA 30338-5883 | 2020-09-08 |
| 1972120970 | Imagine New Beginnings | Clinic/Center | 3125 Colonial Way Apt J, Atlanta, GA 30341-5339 | 2020-06-25 |
| 1659994705 | Paul Smith Counseling and Consulting, LLC | Clinic/Center | 5180 Roswell Rd Ste 106, Atlanta, GA 30342-2293 | 2020-05-24 |
| 1568091429 | Keystone Behavioral Health Center | Clinic/Center | 3071 Campbellton Rd Sw Ste 2, Atlanta, GA 30311-5441 | 2020-04-03 |
| 1205471695 | Mindbrain Institute of Atlanta | Clinic/Center | 2200 Century Pkwy Ne Ste 200, Atlanta, GA 30345-3103 | 2019-11-09 |
| 1528613437 | Kenetta Muhammad | Clinic/Center | 801 Joseph E Boone Blvd Nw, Atlanta, GA 30314-3344 | 2019-08-07 |
| 1356906929 | Lenox Pointe Psychotherapy, LLC | Clinic/Center | 6 Lenox Pointe Ne, Atlanta, GA 30324-3167 | 2019-05-08 |
| 1205352093 | Elite Rose Healthcare Services P.C. | Clinic/Center | 2783 Santa Barbara Dr Nw, Atlanta, GA 30318-7326 | 2017-08-14 |
| 1417478439 | Reexist Counseling LLC | Clinic/Center | 1955 Vance Drive Ne, Atlanta, GA 30345 | 2017-06-29 |
| 1215358015 | Living Fully Psychotherapy and Consulting, LLC | Clinic/Center | 1463 Oxford Rd Ne, Atlanta, GA 30322-1046 | 2013-12-20 |
| Find all providers in ATLANTA | ||||
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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.