Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY003347 | GA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY003347 | GA |
Y | 103G00000X | Clinical Psychologist | PSY003347 | GA |
Y | 103TC0700X | Clinical Psychologist | PSY003347 | GA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY003347 | GA |
N | 103TF0000X | Family Psychologist | PSY003347 | GA |
N | 103TP2701X | Group Psychotherapist | PSY003347 | GA |
NPI | 1487892469 |
---|---|
Provider Name | Dr. Adrian Stanford Janit |
First Address | Martinez, GA 30907-2360 |
Second Address | Martinez, GA 30907-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 29/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
478699634B | (05) | GA |