Provider Demographics
NPI:1720243207
Name:ZOHOURI, FARIDA (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:FARIDA
Middle Name:
Last Name:ZOHOURI
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:FARIDA
Other - Middle Name:
Other - Last Name:ZOHOURI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2536 MARTIN LUTHER KING JR. DR.SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311
Mailing Address - Country:US
Mailing Address - Phone:404-699-7774
Mailing Address - Fax:404-699-7716
Practice Address - Street 1:2536 MARTIN LUTHER KING JR. DR. SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311
Practice Address - Country:US
Practice Address - Phone:404-699-7774
Practice Address - Fax:404-699-7716
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANT9001042101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)