Diana Holberg Gordick, PH.D.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

2739 Issued in GA

Practice address

150 E Ponce de Leon Ave
Suite 350
Decatur, GA 30030-2543

Phone

(404) 985-2732

NPI assigned

Jan 15, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mindbrain Institute of Atlanta

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Atlanta, GA
  • NPI 1205471695
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1356672331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3405",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300313405",
            "telephone_number": "404-985-2732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 E PONCE DE LEON AVE",
            "address_2": "SUITE 350",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302543",
            "telephone_number": "404-985-2732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDICK",
        "first_name": "DIANA",
        "middle_name": "HOLBERG",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-15",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "GA",
            "license": "2739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin David Goodrich, PHARM.D.
• Amanda Goodson, PHARMD
• Persephone Cierra Goodwin
• Kavitha Gopal, M.D.
• Saraswathi Gopal, MD
• Vanessa Gordon-Brown, M.D.
• Omatola Gordon-Rose
• Andrane Monique Gordon, CD
• Antwanette Chardea Gordon
• Candace Gordon

• Counseling Psychologist in Decatur, GA
• Providers in Decatur, GA by specialty
• Counseling Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.