Healthcare Provider Details

I. General information

NPI: 1720249642
Provider Name (Legal Business Name): CYNTHIA DIANE KREUTZER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 SCALES RD STE 302
SUWANEE GA
30024-4340
US

IV. Provider business mailing address

950 SCALES RD STE 302
SUWANEE GA
30024-4340
US

V. Phone/Fax

Practice location:
  • Phone: 404-994-5000
  • Fax: 888-264-8367
Mailing address:
  • Phone: 404-994-5000
  • Fax: 888-264-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003180
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: