Provider Demographics
NPI:1740439389
Name:AZAB, PATRICIA A (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:AZAB
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 GUNN RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-1706
Mailing Address - Country:US
Mailing Address - Phone:478-953-0088
Mailing Address - Fax:
Practice Address - Street 1:102 GUNN RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31028-1706
Practice Address - Country:US
Practice Address - Phone:478-953-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008304101YP2500X
FLMH2119101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor