Individual
DR. GWENDOLYN J CHILDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., PSY.D.
Contact information
Practice address
1012 MAIN ST, STONE MOUNTAIN, GA 30083-2944
(770) 498-2865
(770) 498-8865
Mailing address
462 WATSON BAY, STONE MOUNTAIN, GA 30087-6198
(770) 413-1765
(770) 498-8865
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY001808
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000626381C
—
GA
01
—
10062758
PSYCHOLOGICAL SERVICE
GA
01
—
280737000
PSYCHOLOGICAL SERVICE
GA
01
—
582256356
PSYCHOLOGICAL
GA
Enumeration date
12/30/2006
Last updated
07/09/2007
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