Provider Demographics
NPI:1801444831
Name:PATEL, ISHITA (AMFT)
Entity type:Individual
Prefix:
First Name:ISHITA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PERIMETER CENTER PL NE APT 402
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-4218
Mailing Address - Country:US
Mailing Address - Phone:404-403-7988
Mailing Address - Fax:
Practice Address - Street 1:1755 WOODSTOCK RD STE 200
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2135
Practice Address - Country:US
Practice Address - Phone:770-910-2753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000579106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty