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Organization

Providence Residential & Outpatient Ptsd Services, LLC

NPI Record: ActivePsychologist — Clinical
NPI1215357272
Douglasville, Georgia

Provider's NPPES record last updated: April 17, 2014

Overview

Entity Type
Organization
NPI
1215357272
Primary Specialty
Psychologist — Clinical
Practice Location
Douglasville, Georgia
Organization Subpart
No

Federal Screening

NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.

List of Excluded Individuals/Entities (LEIE)

HHS Office of Inspector General

No potential match identified

No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.

Source data
September 10, 2026
Records indexed
84,001
Screened
Sep 20, 2026, 1:22 PM UTC

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

SAM.gov Exclusions

U.S. General Services Administration

Not checked

SAM.gov Exclusions was not checked.

SAM.gov screening is not configured on this deployment. No SAM check has been performed.

Screened
Not checked

This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

Run a name-based screening

Searches OIG LEIE and SAM.gov by name and reviews every potential match.

Specialties & Taxonomies

  • Psychologist

    Clinical

    Behavioral Health & Social Service Providers

    Primary

    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.

    Taxonomy code 103TC0700X
  • Counselor

    Behavioral Health & Social Service Providers

    A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

    Taxonomy code 101Y00000X
  • Counselor

    Addiction (Substance Use Disorder)

    Behavioral Health & Social Service Providers

    Definition to come...

    Taxonomy code 101YA0400X
  • Counselor

    Professional

    Behavioral Health & Social Service Providers

    Definition to come...

    Taxonomy code 101YP2500X
  • Social Worker

    Behavioral Health & Social Service Providers

    A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public.

    Taxonomy code 104100000X
  • Social Worker

    Clinical

    Behavioral Health & Social Service Providers

    A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

    Taxonomy code 1041C0700X
  • Marriage & Family Therapist

    Behavioral Health & Social Service Providers

    A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

    Taxonomy code 106H00000X
  • Nutritionist

    Dietary & Nutritional Service Providers

    A specialist in adapting and applying food and nutrient knowledge to the solution of food and nutritional problems, the control of disease, and the promotion of health. Nutritionists perform research, instruct groups and individuals about nutritional requirements, and assist people in developing meal patterns that meet their nutritional needs; (2) A nutritionist is someone who has completed undergraduate and/or graduate training in the discipline of nutrition without necessarily meeting the academic and experience requirements to qualify for the Registered Dietitian designation.

    Taxonomy code 133N00000X
  • Dietetic Technician, Registered

    Dietary & Nutritional Service Providers

    A Dietetic Technician, Registered (DTR)/Nutrition and Dietetics Technician, Registered (NDTR) is an individual holding a nationally protected title issued by the Commission on Dietetic Registration (CDR) to qualified individuals who obtain an associate's degree or higher and successfully complete a sliding set of academic, examination, and practice requirements accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) or established by CDR, the nature of which are dependent upon the level of academic degree obtained. The scope of practice of the NDTR focuses on food, nutrition, and dietetics practice, as well as related services. NDTRs work under the supervision of a Registered Dietitian Nutritionist (RDN) when in direct patient/client nutrition care, and may work independently in providing general nutrition education to healthy populations. Patient/client populations include individuals receiving individualized care who have medical conditions or diseases, as well as at-risk individuals receiving personalized nutrition guidance as part of preventive health care.

    Taxonomy code 136A00000X
  • Registered Nurse

    Psychiatric/Mental Health

    Nursing Service Providers

    Definition to come...

    Taxonomy code 163WP0808X
  • Licensed Practical Nurse

    Nursing Service Providers

    An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

    Taxonomy code 164W00000X
  • Acupuncturist

    Other Service Providers

    An acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long, fine needles inserted into specific points in order to treat painful conditions or produce anesthesia.

    Taxonomy code 171100000X
  • Case Manager/Care Coordinator

    Other Service Providers

    A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee's progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management.

    Taxonomy code 171M00000X
  • Psychiatry & Neurology

    Psychiatry

    Allopathic & Osteopathic Physicians

    A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

    Taxonomy code 2084P0800X
  • Technician

    Nursing Service Related Providers

    (1) A person with specialized training in a narrow field of expertise whose occupation requires training and is skilled in specific technical processes and procedures. (2) An individual having special skill or practical knowledge in an area, such as operation and maintenance of equipment or performance of laboratory procedures involving biochemical analyses. Special technical qualifications are normally required, though an increasing number or technicians also possess university degrees in science, and occasionally doctorate degrees. The distinction between technician and technologist in the health care field is not always clear.

    Taxonomy code 374700000X

Provider-Reported License Information

Psychologist (Georgia)
PSY003237
License numbers are reported by the provider to NPPES and are not independently verified by NPISignal against any state licensing board. Confirm current license status directly with the issuing state board.

Practice Locations

Practice Location

6576 Church St

Douglasville, Georgia 30134-1884

Phone: (770) 577-7873

Other Names

  • PropsReported April 17, 2014

Record Information

Enumeration Date
April 17, 2014
Provider's NPPES Record Last Updated
April 17, 2014
NPISignal NPPES Dataset
August 2026

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