Provider Demographics
NPI:1467994020
Name:GOULDING, SANDRA MOORE (PHD, MPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MOORE
Last Name:GOULDING
Suffix:
Gender:F
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1249
Mailing Address - Country:US
Mailing Address - Phone:404-431-5129
Mailing Address - Fax:
Practice Address - Street 1:1459 OXFORD RD NE
Practice Address - Street 2:SUITE 301
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1046
Practice Address - Country:US
Practice Address - Phone:404-827-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical