Provider Demographics
NPI:1326308388
Name:ESKRIDGE, GLORIA 'AMANDA' (MAPC, LAPC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:'AMANDA'
Last Name:ESKRIDGE
Suffix:
Gender:F
Credentials:MAPC, LAPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ESKRIDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAPC, LAPC
Mailing Address - Street 1:1260 CONCORD RD SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5306
Mailing Address - Country:US
Mailing Address - Phone:404-474-7600
Mailing Address - Fax:404-418-6381
Practice Address - Street 1:1260 CONCORD RD SE
Practice Address - Street 2:SUITE 205
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-5306
Practice Address - Country:US
Practice Address - Phone:404-474-7600
Practice Address - Fax:404-418-6381
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007984101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional