Individual
TANJA KETISCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1160 WING ST, ATLANTA, GA 30350-2953
(404) 423-5410
Mailing address
1160 WING ST, ATLANTA, GA 30350-2953
(404) 423-5410
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
1939
AL
103TC0700X
Clinical Psychologist
Primary
PSY004088
GA
Other
Enumeration date
06/23/2015
Last updated
01/04/2025
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