Provider Demographics
NPI:1033646864
Name:OSEJO, AMINTA (LAPC, CADC II, NCC)
Entity Type:Individual
Prefix:
First Name:AMINTA
Middle Name:
Last Name:OSEJO
Suffix:
Gender:F
Credentials:LAPC, CADC II, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 WATERFORD DR SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1739
Mailing Address - Country:US
Mailing Address - Phone:678-779-3920
Mailing Address - Fax:678-666-5031
Practice Address - Street 1:1368 ATLANTA RD SE STE 111
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-3936
Practice Address - Country:US
Practice Address - Phone:678-779-3920
Practice Address - Fax:678-666-5031
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006149101YP2500X
GA874101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional