Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1943 | GA |
Y | 103TC0700X | Clinical Psychologist | 1943 | GA |
NPI | 1003975418 |
---|---|
Provider Name | Andrea M Gamache |
First Address | Atlanta, GA 30356 |
Second Address | Duluth, GA 30096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00693459A | (05) | GA |