Provider Demographics
NPI:1437282431
Name:ONE-TO-ONE PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:ONE-TO-ONE PSYCHOLOGICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDAMARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:229-245-0330
Mailing Address - Street 1:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-2828
Mailing Address - Country:US
Mailing Address - Phone:229-245-0330
Mailing Address - Fax:866-738-7755
Practice Address - Street 1:1223 E MCPHERSON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31639-2351
Practice Address - Country:US
Practice Address - Phone:229-245-0330
Practice Address - Fax:866-738-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001532103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty