Individual
MS. TANYA L GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAMFT
Contact information
Practice address
1815 OLD 41 HWY NW, SUITE 110, KENNESAW, GA 30152-4420
(678) 468-9103
(520) 333-2906
Mailing address
1815 OLD 41 HWY NW, SUITE 110, KENNESAW, GA 30152-4420
(678) 468-9103
(520) 333-2906
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT001356
GA
Other
Enumeration date
08/27/2013
Last updated
09/22/2014
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