Healthcare Provider Details

I. General information

NPI: 1619058146
Provider Name (Legal Business Name): SUSAN JEAN GEDDES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 CREEKSTONE RIDGE
WOODSTOCK GA
30188
US

IV. Provider business mailing address

22 RIVER OAKS DR
CARTERSVILLE GA
30120
US

V. Phone/Fax

Practice location:
  • Phone: 770-546-4517
  • Fax: 770-516-3018
Mailing address:
  • Phone: 770-382-3149
  • Fax: 770-382-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number003394
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: