Provider Demographics
NPI:1932312774
Name:NYMAN, ANASTASIA JUNGBLUT (MS, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:JUNGBLUT
Last Name:NYMAN
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 STEVENS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-7471
Mailing Address - Country:US
Mailing Address - Phone:404-368-5552
Mailing Address - Fax:
Practice Address - Street 1:99 WEATHERSTONE DR
Practice Address - Street 2:SUITE 940
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7005
Practice Address - Country:US
Practice Address - Phone:404-368-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional