Healthcare Provider Details

I. General information

NPI: 1407761828
Provider Name (Legal Business Name): AMINA MIRZA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 HENRY PKWY
MCDONOUGH GA
30253-6636
US

IV. Provider business mailing address

1435 N EXPRESSWAY STE 301
GRIFFIN GA
30223-9014
US

V. Phone/Fax

Practice location:
  • Phone: 770-358-5252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC017066
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: