Healthcare Provider Details

I. General information

NPI: 1528658663
Provider Name (Legal Business Name): ANEELA HASAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 CLAIRMONT RD NE
BROOKHAVEN GA
30329-1043
US

IV. Provider business mailing address

5013 VILLAGE TERRACE DR
DUNWOODY GA
30338-2315
US

V. Phone/Fax

Practice location:
  • Phone: 404-636-1457
  • Fax:
Mailing address:
  • Phone: 404-790-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC007694
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: