Provider Demographics
NPI:1780336115
Name:AZIZ, KHALID ABDUL (BA, CPS-AD, CPS-MH,)
Entity type:Individual
Prefix:MR
First Name:KHALID
Middle Name:ABDUL
Last Name:AZIZ
Suffix:
Gender:F
Credentials:BA, CPS-AD, CPS-MH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2247
Mailing Address - Country:US
Mailing Address - Phone:670-734-2667
Mailing Address - Fax:
Practice Address - Street 1:1159 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2247
Practice Address - Country:US
Practice Address - Phone:678-734-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)