Provider Demographics
NPI:1881124105
Name:BAL, SURINDER KAUR (PHD)
Entity type:Individual
Prefix:DR
First Name:SURINDER
Middle Name:KAUR
Last Name:BAL
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 1:11815 NORTHFALL LN STE 1006
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7973
Mailing Address - Country:US
Mailing Address - Phone:404-662-6077
Mailing Address - Fax:
Practice Address - Street 1:11815 NORTHFALL LN STE 1006
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7973
Practice Address - Country:US
Practice Address - Phone:404-662-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009342101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
XXXXXOtherI DO NOT HAVE ANY OTHER IDENTIFIERS