Provider Demographics
NPI:1518100890
Name:NEWBY, WENDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:NEWBY
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 1:1525 RICHARD STOKES DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2207
Mailing Address - Country:US
Mailing Address - Phone:404-636-7624
Mailing Address - Fax:
Practice Address - Street 1:1525 RICHARD STOKES DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2207
Practice Address - Country:US
Practice Address - Phone:404-636-7624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002254103TS0200X
NC2379103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool