Provider Demographics
NPI:1275114795
Name:HORAK, ANDILYN NICHOLE (LPC)
Entity Type:Individual
Prefix:
First Name:ANDILYN
Middle Name:NICHOLE
Last Name:HORAK
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 1:738 WOODLAWN DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4253
Mailing Address - Country:US
Mailing Address - Phone:770-702-1161
Mailing Address - Fax:
Practice Address - Street 1:738 WOODLAWN DR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4253
Practice Address - Country:US
Practice Address - Phone:404-803-9256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GALPC013988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0926040420OtherOUR FACILITY DOES NOT ACCEPT MEDICARE.