Provider Demographics
NPI:1639422520
Name:SINGH, ANNELIESE AMANDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNELIESE
Middle Name:AMANDA
Last Name:SINGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WILTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1436
Mailing Address - Country:US
Mailing Address - Phone:404-849-8186
Mailing Address - Fax:
Practice Address - Street 1:75 WILTSHIRE DR
Practice Address - Street 2:
Practice Address - City:AVONDALE ESTATES
Practice Address - State:GA
Practice Address - Zip Code:30002-1436
Practice Address - Country:US
Practice Address - Phone:404-849-8186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC00431101YP2500X
GAPSY003371103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling