Provider Demographics
NPI:1942379425
Name:PATZER, MILDRED PEDEN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:PEDEN
Last Name:PATZER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MILDRED
Other - Middle Name:LISA
Other - Last Name:PATZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:5400 LAUREL SPRING PKWY
Mailing Address - Street 2:SUITE 602
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-849-5286
Mailing Address - Fax:770-781-8894
Practice Address - Street 1:5400 LAUREL SPRING PKWY
Practice Address - Street 2:SUITE 602
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-849-5286
Practice Address - Fax:770-781-8894
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001638101YP2500X
GALPC1638101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor