Provider Demographics
NPI:1356976930
Name:PSAREAS, NADINE BLASE (CADC II, ICADC,)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:BLASE
Last Name:PSAREAS
Suffix:
Gender:F
Credentials:CADC II, ICADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 POPE CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8418
Mailing Address - Country:US
Mailing Address - Phone:770-224-6825
Mailing Address - Fax:770-224-6826
Practice Address - Street 1:1558 MARIETTA HWY STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3615
Practice Address - Country:US
Practice Address - Phone:770-224-6825
Practice Address - Fax:770-224-6826
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19-07-22-1180174H00000X
GA1369101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No174H00000XOther Service ProvidersHealth Educator