Provider Demographics
NPI:1093087876
Name:GANSKE, KATHRYN (PHD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GANSKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 HASCALL RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1549 CLAIRMONT RD
Practice Address - Street 2:SUITE 108
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4639
Practice Address - Country:US
Practice Address - Phone:770-309-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3300103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling