Provider Demographics
NPI:1508502881
Name:WONDRASEK, AARON M (MA, LAPC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:M
Last Name:WONDRASEK
Suffix:
Gender:M
Credentials:MA, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 ALFORD CMNS
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-7043
Mailing Address - Country:US
Mailing Address - Phone:404-788-6180
Mailing Address - Fax:
Practice Address - Street 1:4660 ALFORD CMNS
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-7043
Practice Address - Country:US
Practice Address - Phone:404-788-6180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAPC007858OtherNONE