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General NPI Number Information
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NPI Number | 1346562774
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Entity Type | Individual
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Provider Name | OLIVIA CHANTE' FRAZIER LPC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 130 HOWELL RD STE D
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City | TYRONE
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State | GA
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Zip | 30290-2097
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Country | US
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Telephone | 404-451-1631
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Fax |
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Provider Business Mailing Address
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Address Line | 595 OLD GREENVILLE RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-5930
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Country | US
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Telephone | 404-451-1631
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC005812
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License Number State | GA
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