Healthcare Provider Details

I. General information

NPI: 1417374141
Provider Name (Legal Business Name): GUNTER PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 WELLINGTON WALK SW
ATLANTA GA
30331-5452
US

IV. Provider business mailing address

3205 WELLINGTON WALK SW
ATLANTA GA
30331-5452
US

V. Phone/Fax

Practice location:
  • Phone: 404-788-1925
  • Fax:
Mailing address:
  • Phone: 404-788-1925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License NumberPSY003145
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003145
License Number StateGA

VIII. Authorized Official

Name: DR. KENSA K. GUNTER
Title or Position: OWNER/SOLE MEMBER
Credential: PSY.D.
Phone: 404-788-1925