Provider Demographics
NPI:1134844095
Name:GANDY, KIANA MARCELLE (APC, NCC, MS)
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:MARCELLE
Last Name:GANDY
Suffix:
Gender:F
Credentials:APC, NCC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 HOWARD ST SE UNIT 4405
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2367
Mailing Address - Country:US
Mailing Address - Phone:253-202-0065
Mailing Address - Fax:
Practice Address - Street 1:555 SUN VALLEY DR STE L3
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5630
Practice Address - Country:US
Practice Address - Phone:678-395-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007826101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health