Provider Demographics
NPI:1942667704
Name:D'AVERSA, LEOLA (LPC)
Entity Type:Individual
Prefix:
First Name:LEOLA
Middle Name:
Last Name:D'AVERSA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 BAKER RD NW STE 304-1002
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4600
Mailing Address - Country:US
Mailing Address - Phone:770-284-9252
Mailing Address - Fax:
Practice Address - Street 1:2090 BAKER RD NW STE 304-1002
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4600
Practice Address - Country:US
Practice Address - Phone:678-322-7845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health