Healthcare Provider Details

I. General information

NPI: 1518177542
Provider Name (Legal Business Name): BARBARA GULESSERIAN WARNER MS, PMHCNS - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 EAGLES HARBOR DR
HODGES SC
29653-9085
US

IV. Provider business mailing address

754 EAGLES HARBOR DR
HODGES SC
29653-9085
US

V. Phone/Fax

Practice location:
  • Phone: 678-427-1404
  • Fax:
Mailing address:
  • Phone: 678-427-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number3056
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: