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General NPI Number Information
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NPI Number | 1003078569
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Entity Type | Organization
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Legal Business Name | NANCY GUP AND ASSOCIATES, INC.
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 2885 PAYTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30345-2600
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Country | US
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Telephone | 404-634-0014
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Fax | 404-728-0043
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Provider Business Mailing Address
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Address Line | 2885 PAYTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30345-2600
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Country | US
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Telephone | 404-634-0014
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Fax | 404-728-0043
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/OWNER
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Name | DR. NANCY JANE GUP
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Credential | PSY.D.
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Telephone | 404-634-0014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2414
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License Number State | GA
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