Provider Demographics
NPI:1518007129
Name:ULRICI, DONNA KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:KAY
Last Name:ULRICI
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 1:1501 BEND CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-2703
Mailing Address - Country:US
Mailing Address - Phone:770-668-0350
Mailing Address - Fax:
Practice Address - Street 1:1864 INDEPENDENCE SQ
Practice Address - Street 2:SUITE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5173
Practice Address - Country:US
Practice Address - Phone:770-668-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1036103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00353757CMedicaid
GA00353757CMedicaid