Provider Demographics
NPI:1124240882
Name:GAYA, PATRICIA (BS, LMFT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GAYA
Suffix:
Gender:F
Credentials:BS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 LINCOLN PKWY E
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2209
Mailing Address - Country:US
Mailing Address - Phone:678-666-4717
Mailing Address - Fax:404-201-2912
Practice Address - Street 1:1455 LINCOLN PKWY E
Practice Address - Street 2:SUITE 240
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-2209
Practice Address - Country:US
Practice Address - Phone:678-666-4717
Practice Address - Fax:404-201-2912
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001307106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003151867AMedicaid
GAMFT001307OtherLICENSE GEORGIA