Provider Demographics
NPI:1508241522
Name:GONZALEZ ERIGOLLA, CLAUDIA (PSYD)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:GONZALEZ ERIGOLLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10375 FORD AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-9037
Mailing Address - Country:US
Mailing Address - Phone:912-500-5800
Mailing Address - Fax:912-500-2902
Practice Address - Street 1:10375 FORD AVE STE 3
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-9037
Practice Address - Country:US
Practice Address - Phone:912-500-5800
Practice Address - Fax:912-500-2902
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004437103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty