Provider Demographics
NPI:1104279637
Name:DUNSTON, GLORIA
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:DUNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 RIDENOUR PKWY NW
Mailing Address - Street 2:APT. 1823
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4714
Mailing Address - Country:US
Mailing Address - Phone:336-437-7372
Mailing Address - Fax:
Practice Address - Street 1:1575 RIDENOUR PKWY NW
Practice Address - Street 2:APT. 1823
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4714
Practice Address - Country:US
Practice Address - Phone:336-437-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional