Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY001656 | GA |
N | 103TC0700X | Clinical Psychologist | PSY001656 | GA |
N | 103G00000X | Clinical Psychologist | PSY001656 | GA |
N | 103TC0700X | Clinical Psychologist | PSY001656 | GA |
N | 103TH0100X | Health Service | PSY001656 | GA |
NPI | 1114037561 |
---|---|
Provider Name | Dr. Carla A Hedeen |
First Address | Decatur, GA 30031-1494 |
Second Address | Decatur, GA 30033-6149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R12892 | (02) | GA |