Provider Demographics
NPI:1184847212
Name:MEAUX, GLORIA DESANTIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:DESANTIS
Last Name:MEAUX
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 1:18 LENOX POINTE NE # B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3168
Mailing Address - Country:US
Mailing Address - Phone:404-841-9293
Mailing Address - Fax:404-841-9296
Practice Address - Street 1:18 LENOX POINTE NE # B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3168
Practice Address - Country:US
Practice Address - Phone:404-841-9293
Practice Address - Fax:404-841-9296
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1735103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily