Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Coastal Georgia Psychodynamic Center, LLC

Organization Clinical Psychologist · NPI 1871033654

Coastal Georgia Psychodynamic Center, LLC is a Clinical Psychologist in Statesboro, Georgia. Licensed in Georgia. Registered with an NPI since 2017.

Licensed in
GA
In the registry since
2017
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

325 S Walnut St
Statesboro, GA 30458-5418
Phone: (912) 421-9050
Fax: (912) 623-4918
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence PSY003907 (GA)

Record details

NPI number1871033654
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Amanda Rickard — Organizer · (912) 421-9050
NPI enumeratedFebruary 28, 2017
Last updated in NPPESMay 11, 2020
Certification dateMay 11, 2020
Mailing address325 S Walnut St, Statesboro, GA 30458-5418

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