Healthcare Provider Details

I. General information

NPI: 1659047660
Provider Name (Legal Business Name): ROSYLIA EUNIKA GUMBS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2369 CENTENARY WAY CT
DACULA GA
30019-1329
US

IV. Provider business mailing address

2369 CENTENARY WAY CT
DACULA GA
30019-1329
US

V. Phone/Fax

Practice location:
  • Phone: 706-399-4329
  • Fax:
Mailing address:
  • Phone: 706-399-4329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC012386
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: