Provider Demographics
NPI:1437369246
Name:SADEGHI, VAHID AZIMZADEH (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:VAHID
Middle Name:AZIMZADEH
Last Name:SADEGHI
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 PEACHFORD RD
Mailing Address - Street 2:SUITE S,
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6520
Mailing Address - Country:US
Mailing Address - Phone:770-457-1848
Mailing Address - Fax:770-516-3018
Practice Address - Street 1:2150 PEACHFORD RD
Practice Address - Street 2:SUITE S,
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6520
Practice Address - Country:US
Practice Address - Phone:770-457-1848
Practice Address - Fax:770-516-3018
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000742106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist