Provider Demographics
NPI:1801584644
Name:ISPAS, VIOREL STEFAN (LPC, AMFT)
Entity type:Individual
Prefix:MR
First Name:VIOREL
Middle Name:STEFAN
Last Name:ISPAS
Suffix:
Gender:M
Credentials:LPC, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BENJAMIN CT
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1784
Mailing Address - Country:US
Mailing Address - Phone:770-313-7475
Mailing Address - Fax:
Practice Address - Street 1:2055 MOUNT PARAN RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2921
Practice Address - Country:US
Practice Address - Phone:770-313-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013658101YP2500X, 101YM0800X
GAAMFT000594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist