Provider Demographics
NPI:1295933877
Name:MALINAJDOVSKA-BASS, LJUBICA BLAZE (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:LJUBICA
Middle Name:BLAZE
Last Name:MALINAJDOVSKA-BASS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:DR
Other - First Name:LJUBICA
Other - Middle Name:BLAZE
Other - Last Name:MALINAJDOVSKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:3645 MARKETPLACE BLVD
Mailing Address - Street 2:266
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5747
Mailing Address - Country:US
Mailing Address - Phone:678-754-4584
Mailing Address - Fax:
Practice Address - Street 1:3645 MARKETPLACE BLVD
Practice Address - Street 2:266
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5747
Practice Address - Country:US
Practice Address - Phone:678-754-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional