Healthcare Provider Details

I. General information

NPI: 1073023164
Provider Name (Legal Business Name): NICHOLAS ROBERT MARZO LPC, LMHC, CST-S, AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 CHAMBLEE DUNWOODY RD STE D2
CHAMBLEE GA
30341-2064
US

IV. Provider business mailing address

3228 WAKEFIELD ST
LAWRENCEVILLE GA
30044-5677
US

V. Phone/Fax

Practice location:
  • Phone: 678-802-9355
  • Fax:
Mailing address:
  • Phone: 404-313-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC004808
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: