Provider Demographics
NPI:1518332121
Name:KRISHNAN, GIRISHKUMAR (LAPC)
Entity Type:Individual
Prefix:
First Name:GIRISHKUMAR
Middle Name:
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:LAPC
Other - Prefix:
Other - First Name:KUMAR
Other - Middle Name:
Other - Last Name:KRISHNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:352 PARK AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3336
Mailing Address - Country:US
Mailing Address - Phone:404-247-5589
Mailing Address - Fax:678-784-4294
Practice Address - Street 1:2050 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3811
Practice Address - Country:US
Practice Address - Phone:678-784-4293
Practice Address - Fax:678-784-4294
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional