Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 3300 | GA |
NPI | 1093087876 |
---|---|
Provider Name | Kathryn Ganske |
First Address | Atlanta, GA 30309-2228 |
Second Address | Decatur, GA 30033-4639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2012 |
Last Update Date | 08/02/2012 |