Provider Demographics
NPI:1851455307
Name:VAZQUEZ, ANGELICA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7506 SAINT DAVID ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3096
Mailing Address - Country:US
Mailing Address - Phone:678-396-1970
Mailing Address - Fax:
Practice Address - Street 1:7506 SAINT DAVID ST
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-3096
Practice Address - Country:US
Practice Address - Phone:678-396-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006493106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist