Provider Demographics
NPI:1679908578
Name:BUCHHOLZ, JESSICA NEWMAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:NEWMAN
Last Name:BUCHHOLZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3461
Mailing Address - Country:US
Mailing Address - Phone:470-736-9595
Mailing Address - Fax:678-550-9093
Practice Address - Street 1:3160 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:470-736-9595
Practice Address - Fax:678-550-9093
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical