Provider Demographics
NPI:1639667496
Name:ZOBANOV, EMILY (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ZOBANOV
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 FAIRWOOD BND NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7864
Mailing Address - Country:US
Mailing Address - Phone:727-543-7681
Mailing Address - Fax:
Practice Address - Street 1:5205 STILESBORO RD NW STE 225
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7748
Practice Address - Country:US
Practice Address - Phone:727-543-7681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health