Healthcare Provider Details

I. General information

NPI: 1740439389
Provider Name (Legal Business Name): PATRICIA A AZAB LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GUNN RD
CENTERVILLE GA
31028-1706
US

IV. Provider business mailing address

102 GUNN RD
CENTERVILLE GA
31028-1706
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-0088
  • Fax:
Mailing address:
  • Phone: 478-953-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH2119
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number008304
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: