Provider Demographics
NPI:1295106623
Name:CAPPARUCCI, EDMUND (LPC, CSAS, CPCS)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:CAPPARUCCI
Suffix:
Gender:M
Credentials:LPC, CSAS, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 SANDY PLAINS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4291
Mailing Address - Country:US
Mailing Address - Phone:404-788-0002
Mailing Address - Fax:855-729-8887
Practice Address - Street 1:2625 SANDY PLAINS RD STE 204
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4291
Practice Address - Country:US
Practice Address - Phone:404-788-0002
Practice Address - Fax:855-729-8887
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional