Provider Demographics
NPI:1033599279
Name:EPELBAUM, LEAH (LPC)
Entity Type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:
Last Name:EPELBAUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:LEAH
Other - Middle Name:T
Other - Last Name:AL-HABIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APC
Mailing Address - Street 1:6175 HICKORY FLAT HWY STE 110-111
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7207
Mailing Address - Country:US
Mailing Address - Phone:770-286-1237
Mailing Address - Fax:
Practice Address - Street 1:6175 HICKORY FLAT HWY STE 110-111
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-7207
Practice Address - Country:US
Practice Address - Phone:770-286-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC010655OtherGEORGIA SECRETARY OF STATE LICENSING BOARD