Healthcare Provider Details

I. General information

NPI: 1578269726
Provider Name (Legal Business Name): ALEXANDRA GUZMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 JOHNSON FY RD NE STE 350
ATLANTA GA
30342-4735
US

IV. Provider business mailing address

975 JOHNSON FY RD NE STE 350
ATLANTA GA
30342-4735
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-3869
  • Fax:
Mailing address:
  • Phone: 404-785-3869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006192
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: