Provider Demographics
NPI:1689964660
Name:CAPPARELLI, TANIA MARIA (LMFT)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:MARIA
Last Name:CAPPARELLI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 PARK MANOR DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-2821
Mailing Address - Country:US
Mailing Address - Phone:770-557-5582
Mailing Address - Fax:770-450-8565
Practice Address - Street 1:721 PARK MANOR DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2821
Practice Address - Country:US
Practice Address - Phone:770-557-5582
Practice Address - Fax:770-450-8565
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA866577945AMedicaid