Provider Demographics
NPI:1255465845
Name:OBERHAND, ALICIA BABENCO (LPC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:BABENCO
Last Name:OBERHAND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 KAOLIN CT
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7365
Mailing Address - Country:US
Mailing Address - Phone:973-477-3131
Mailing Address - Fax:
Practice Address - Street 1:5480 MCGINNIS VILLAGE PL STE 104
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-1746
Practice Address - Country:US
Practice Address - Phone:973-477-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00245800101YM0800X
GALPC010625101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC010625OtherPROFESSIONAL COUNSELOR