Provider Demographics
NPI:1720120058
Name:VARGHESE, SHUBHA SWAMY
Entity Type:Individual
Prefix:MRS
First Name:SHUBHA
Middle Name:SWAMY
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHUBHA
Other - Middle Name:
Other - Last Name:SWAMY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1225 JOHNSON FERRY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2727
Mailing Address - Country:US
Mailing Address - Phone:770-847-0358
Mailing Address - Fax:
Practice Address - Street 1:1225 JOHNSON FERRY RD STE 170
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2727
Practice Address - Country:US
Practice Address - Phone:770-847-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health