Healthcare Provider Details

I. General information

NPI: 1639264120
Provider Name (Legal Business Name): LINDA PAK BRUNER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA PAK PH.D.

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 POWERS FERRY ROAD SE, BUILDING 9, SUITE 100 THE ANXIETY & STRESS MANAGEMENT INSTITUTE
MARIETTA GA
30067-5491
US

IV. Provider business mailing address

185 BOLLING ROAD LINDA PAK, LLC
ATLANTA GA
30305
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-0080
  • Fax: 770-953-0031
Mailing address:
  • Phone: 404-386-0271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: