Provider Demographics
NPI:1942979679
Name:GOZA-FREEMAN, TARA R (LAPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:R
Last Name:GOZA-FREEMAN
Suffix:
Gender:F
Credentials:LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 DALE LN SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2514
Mailing Address - Country:US
Mailing Address - Phone:404-997-1943
Mailing Address - Fax:
Practice Address - Street 1:3456 DALE LN SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2514
Practice Address - Country:US
Practice Address - Phone:404-997-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional