Provider Demographics
NPI:1710517073
Name:CLONTZ, NADYA (LAPC)
Entity Type:Individual
Prefix:
First Name:NADYA
Middle Name:
Last Name:CLONTZ
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OLD PEACHTREE RD NW UNIT 24
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3316
Mailing Address - Country:US
Mailing Address - Phone:770-883-8768
Mailing Address - Fax:
Practice Address - Street 1:4411 SUWANEE DAM RD STE 450
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8706
Practice Address - Country:US
Practice Address - Phone:770-331-6592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006803101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor