11D2148279 CLIA NUMBER - POPULATIONS AND INTERVENTIONS TEAM COMPANY (PITC)

Laboratory Demographics

CLIA Number: 11D2148279

Facility Name: POPULATIONS AND INTERVENTIONS TEAM COMPANY (PITC)

Facility Address:
3182 BERTHAS OVERLOOK
DOUGLASVILLE, GA
ZIP 30135
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Facility Phone Number: 678 310-9707

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1528587367

Taxonomy: 103TC0700X - Psychologist
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

CLIA Record

Field Name	Field Value
CLIA Number	11D2148279
LAB Type	Independent
Facility Name	POPULATIONS AND INTERVENTIONS TEAM COMPANY (PITC)
Street	3182 BERTHAS OVERLOOK
City	DOUGLASVILLE
State	GA
ZIP	30135
Phone	678 310-9707
CertificateType	4
CertificateEffectiveDate	5/8/2022
CertificateExpirationDate	5/7/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024