Provider Demographics
NPI:1790511491
Name:GESSNER, DARYL
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:GESSNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N TENNESSEE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2490
Mailing Address - Country:US
Mailing Address - Phone:770-608-8447
Mailing Address - Fax:
Practice Address - Street 1:911 N TENNESSEE ST STE 104
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2490
Practice Address - Country:US
Practice Address - Phone:770-608-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional