Individual
GIM MICHAEL REO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6965
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6965
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810007928
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/18/2020
Last updated
01/21/2023
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