Provider Demographics
NPI:1407421233
Name:SOULAKOS, ANGELIQUE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:SOULAKOS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 DIVIDEND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1934
Mailing Address - Country:US
Mailing Address - Phone:770-344-7208
Mailing Address - Fax:
Practice Address - Street 1:313 DIVIDEND DR STE 300
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1934
Practice Address - Country:US
Practice Address - Phone:770-344-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health