1093766719 NPI number — INNERACTION PSYCHOLOGICAL ASSOCIATES, P.C.

Table of content: (NPI 1093766719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093766719 NPI number — INNERACTION PSYCHOLOGICAL ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNERACTION PSYCHOLOGICAL ASSOCIATES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TERESSA HAEGER, PH.D.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093766719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 489
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAHLONEGA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30533-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-864-0186
Provider Business Mailing Address Fax Number:
706-864-0963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 CROWN MOUNTAIN PL
Provider Second Line Business Practice Location Address:
SUITE C200
Provider Business Practice Location Address City Name:
DAHLONEGA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30533-1627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-864-0186
Provider Business Practice Location Address Fax Number:
706-864-0963
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAEGER
Authorized Official First Name:
TERESSA
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-864-0186

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY000773 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000680996C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000680996D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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