Childs, Gwendolyn J
Childs, Gwendolyn J is an sole proprietor health care provider with primary practice located at 1012 Main St , Stone Mountain GA 30083-2944. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Childs, Gwendolyn J can be contacted via phone (770) 498-2865.Contact Information
Primary practice address
1012 Main St
Stone Mountain GA 30083-2944
Phone: (770) 498-2865
Fax: (770) 498-8865
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PSY001808 | Georgia |
Profile Details
| NPI number | 1639235799 |
|---|---|
| LBN Legal business name | Childs, Gwendolyn J |
| Credentials | M.A., PSY.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 30th, 2006 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639235799 | NPPES |
| Georgia | MEDICAID | 000626381C | |
| Georgia | Other | 10062758 | |
| Georgia | Other | 280737000 | |
| Georgia | Other | 582256356 |
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