Provider Demographics
NPI:1801496864
Name:PATEL, POONAM A
Entity type:Individual
Prefix:
First Name:POONAM
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8735 DUNWOODY PL STE 5364
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2995
Mailing Address - Country:US
Mailing Address - Phone:256-595-9342
Mailing Address - Fax:
Practice Address - Street 1:8735 DUNWOODY PL # 5364
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2995
Practice Address - Country:US
Practice Address - Phone:256-595-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007213101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA007213OtherGA BOARD OF PROFESSIONAL LICENSING -ASSOCIATE PROFESSIONAL COUNSELOR
GA997665OtherNATIONAL CERTIFIED COUNSELOR