Provider Demographics
NPI:1649339961
Name:ENTESARY, DARIUS (LPC)
Entity type:Individual
Prefix:MR
First Name:DARIUS
Middle Name:
Last Name:ENTESARY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7258
Mailing Address - Country:US
Mailing Address - Phone:404-886-2362
Mailing Address - Fax:404-305-7947
Practice Address - Street 1:1902 MACY DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-6339
Practice Address - Country:US
Practice Address - Phone:678-457-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health