Provider Demographics
NPI:1740757947
Name:PATEL, NISHA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BUFORD HWY NE STE 530
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2143
Mailing Address - Country:US
Mailing Address - Phone:678-896-0050
Mailing Address - Fax:
Practice Address - Street 1:2801 BUFORD HWY NE STE 530
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2143
Practice Address - Country:US
Practice Address - Phone:404-721-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health