Healthcare Provider Details

I. General information

NPI: 1366946154
Provider Name (Legal Business Name): AMMERETA LEANNA GASKIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 COUNTRY CLUB DR
STOCKBRIDGE GA
30281-7349
US

IV. Provider business mailing address

275 COUNTRY CLUB DR
STOCKBRIDGE GA
30281-7349
US

V. Phone/Fax

Practice location:
  • Phone: 770-474-8400
  • Fax: 770-474-3738
Mailing address:
  • Phone: 770-474-8400
  • Fax: 770-474-3738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001556
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2298
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: