Provider Demographics
NPI:1831478098
Name:AVE-LALLEMANT, PATRICIA (LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:AVE-LALLEMANT
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:PO BOX 88673
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30356-8673
Mailing Address - Country:US
Mailing Address - Phone:678-923-6221
Mailing Address - Fax:
Practice Address - Street 1:3349 ASBURY SQ
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-2419
Practice Address - Country:US
Practice Address - Phone:678-923-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0958101YA0400X
GAMFT001203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)