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General NPI Number Information
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NPI Number | 1255465845
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Entity Type | Individual
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Provider Name | ALICIA BABENCO OBERHAND LPC
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 5480 MCGINNIS VILLAGE PL STE 104
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City | ALPHARETTA
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State | GA
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Zip | 30005-1746
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Country | US
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Telephone | 973-477-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 230 KAOLIN CT
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City | JOHNS CREEK
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State | GA
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Zip | 30022-7365
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Country | US
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Telephone | 973-477-3131
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37PC00245800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC010625
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License Number State | GA
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