Individual
MRS. WESDYDA DORIVAL GASSANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1623 GREAT SHOALS CIRCLE, LAWRENCEVILLE, GA 30045
(678) 330-8054
Mailing address
1392 PRESERVE PARK DR, LOGANVILLE, GA 30052-5828
(678) 330-8054
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
9583541
FL
163WP0200X
Pediatric Registered Nurse
9583541
FL
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
9583541
FL
164W00000X
Licensed Practical Nurse
Primary
LPN
GA
164W00000X
Licensed Practical Nurse
LPN085393
GA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
9583541
FL
Other
Enumeration date
12/26/2017
Last updated
06/26/2023
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