Provider Demographics
NPI:1437612322
Name:JEAN-GRATIA, ESTHER (PSYD)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:JEAN-GRATIA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:
Other - Last Name:JEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 CHERI PL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-4580
Mailing Address - Country:US
Mailing Address - Phone:678-222-6316
Mailing Address - Fax:
Practice Address - Street 1:9757 BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4167
Practice Address - Country:US
Practice Address - Phone:706-455-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004274103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist