Provider Demographics
NPI:1942768544
Name:GUILD, DANIELLE JUSTINE (PHD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JUSTINE
Last Name:GUILD
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 1:820 EBENEZER CHURCH RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2073
Mailing Address - Country:US
Mailing Address - Phone:404-960-1282
Mailing Address - Fax:
Practice Address - Street 1:820 EBENEZER CHURCH RD STE 110
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-2073
Practice Address - Country:US
Practice Address - Phone:404-960-1282
Practice Address - Fax:855-817-2428
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical