Individual
MS. CRYSTAL N GAULDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2394
Mailing address
3065 SABLE TRAIL, ATLANTA, GA 30349
(404) 405-9030
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
006103
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006103
—
GA
Enumeration date
09/03/2013
Last updated
09/03/2013
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