Provider Demographics
NPI:1073289914
Name:GOMEZ SOLER, MARIA (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GOMEZ SOLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MONTGOMERY FERRY DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2713
Mailing Address - Country:US
Mailing Address - Phone:203-539-1521
Mailing Address - Fax:
Practice Address - Street 1:126 MONTGOMERY FERRY DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2713
Practice Address - Country:US
Practice Address - Phone:203-539-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty