Basic Information
| Provider Information | |||||||||
| NPI: | 1881724888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWMAN | ||||||||
| FirstName: | SPOMENKA | ||||||||
| MiddleName: | CALIC | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 753 MOUNTAIN OAKS PKWY | ||||||||
| Address2: | |||||||||
| City: | STONE MOUNTAIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300874739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708798718 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 223 SCENIC HWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300455603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709951846 | ||||||||
| FaxNumber: | 7709956614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | X | Behavioral Health & Social Service Providers | Psychologist | 103TB0200X | X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | PSY003069 | GA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.