Healthcare Provider Details

I. General information

NPI: 1770338733
Provider Name (Legal Business Name): KAZIA CORTEL-FRASER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3295 RIVER EXCHANGE DR STE 135
PEACHTREE CORNERS GA
30092-4220
US

IV. Provider business mailing address

3295 RIVER EXCHANGE DR STE 135
NORCROSS GA
30092-4220
US

V. Phone/Fax

Practice location:
  • Phone: 678-466-0972
  • Fax:
Mailing address:
  • Phone: 678-517-8609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC017114
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: