Provider Demographics
NPI:1114898798
Name:GOMEZ RODRIGUEZ, ELIANA VANESA (MS)
Entity type:Individual
Prefix:
First Name:ELIANA
Middle Name:VANESA
Last Name:GOMEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 KIMBALL BRIDGE RD # 110
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1404
Mailing Address - Country:US
Mailing Address - Phone:404-388-3909
Mailing Address - Fax:
Practice Address - Street 1:3060 KIMBALL BRIDGE RD # 110
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1404
Practice Address - Country:US
Practice Address - Phone:404-388-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional