Provider Demographics
NPI:1871033753
Name:ESEZOBOR, AUGUSTINE (LPC, PHD)
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:
Last Name:ESEZOBOR
Suffix:
Gender:M
Credentials:LPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 JEFFERSON ST
Mailing Address - Street 2:SUITE 6 & 8
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-4054
Mailing Address - Country:US
Mailing Address - Phone:770-765-5917
Mailing Address - Fax:866-718-3107
Practice Address - Street 1:2777 JEFFERSON ST
Practice Address - Street 2:SUITE 6 & 8
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-4054
Practice Address - Country:US
Practice Address - Phone:770-765-5917
Practice Address - Fax:866-718-3107
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002158101YP2500X
GA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool