Healthcare Provider Details

I. General information

NPI: 1942768544
Provider Name (Legal Business Name): DANIELLE JUSTINE GUILD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 EBENEZER CHURCH RD STE 110
SHARPSBURG GA
30277-2073
US

IV. Provider business mailing address

820 EBENEZER CHURCH RD STE 110
SHARPSBURG GA
30277-2073
US

V. Phone/Fax

Practice location:
  • Phone: 404-960-1282
  • Fax: 855-817-2428
Mailing address:
  • Phone: 404-960-1282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004277
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: