Provider Demographics
NPI:1144877713
Name:GITTENS, CATHY (CATHY GITTENS CPS-P)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:GITTENS
Suffix:
Gender:F
Credentials:CATHY GITTENS CPS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 E LAKE PKWY STE 278
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4802
Mailing Address - Country:US
Mailing Address - Phone:404-667-9664
Mailing Address - Fax:
Practice Address - Street 1:1016 ARBOR WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8716
Practice Address - Country:US
Practice Address - Phone:404-667-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAN.A.Medicaid