Individual
GARY SANTAVICCA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
340 BLVD NE, STE 640, ATLANTA, GA 30312
(404) 653-1117
(404) 880-0133
Mailing address
340 BLVD NE, STE 640, ATLANTA, GA 30312
(404) 653-1117
(404) 880-0133
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1224
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00423178A
—
GA
Enumeration date
04/04/2006
Last updated
07/08/2007
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