Provider Demographics
NPI:1114136603
Name:MATHEUS, MARIANELA (LPC,CPCS,RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARIANELA
Middle Name:
Last Name:MATHEUS
Suffix:
Gender:F
Credentials:LPC,CPCS,RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 BEAUMONT LN
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4500
Mailing Address - Country:US
Mailing Address - Phone:770-351-9033
Mailing Address - Fax:770-772-0355
Practice Address - Street 1:2050 BEAUMONT LN
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4500
Practice Address - Country:US
Practice Address - Phone:770-351-9033
Practice Address - Fax:770-772-0355
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002525101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003200881AMedicaid