| Doctor Name: | KELLIE GWALTNEY |
| NPI Number: | 1194829572 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LAPC |
| License Number: | APC002918 |
| Business Practice Address: | 2750 Old Alabama Rd Suite 200 Johns Creek, GA - 300228593 |
| Business Phone Number: | 6788935300 |
| Business Fax Number: | 6788935312 |
| Mailing Address: | 2750 Old Alabama Rd, Suite 200 JOHNS CREEK |
| State: | GA |
| Postal Code: | 300228593 |
| Phone Number: | 6788935300 |
| Fax Number: | 6788935312 |
| NPI Enumeration Date: | 09/07/2006 |
| NPI Last Update Date: | 02/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | APC002918 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |