Individual
DR. GUSTAVO RAFAEL GRODNITZKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
736 MITCH DR, WINSTON SALEM, NC 27104-5126
(336) 659-8058
Mailing address
736 MITCH DR, WINSTON SALEM, NC 27104-5126
(336) 659-8058
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2810
NC
Other
Enumeration date
12/23/2009
Last updated
01/05/2010
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