Healthcare Provider Details

I. General information

NPI: 1437392081
Provider Name (Legal Business Name): OLISA YAA AJINAKU LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 DANNON VW SW STE 3202
ATLANTA GA
30331-2161
US

IV. Provider business mailing address

920 DANNON VIEW SUITE 3202
ATLANTA GA
30331
US

V. Phone/Fax

Practice location:
  • Phone: 404-346-3471
  • Fax: 404-346-3473
Mailing address:
  • Phone: 404-346-3471
  • Fax: 404-346-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC003694
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: