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General NPI Number Information
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NPI Number | 1376128975
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Entity Type | Individual
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Provider Name | ASHLEY J. TANZOSH MS, NCC, LAPC
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Gender | Female
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 621 NORTH AVE NE STE 100
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City | ATLANTA
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State | GA
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Zip | 30308-2857
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Country | US
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Telephone | 404-947-8344
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Fax |
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Provider Business Mailing Address
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Address Line | 3241 ROCKBRIDGE RD
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City | AVONDALE ESTATES
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State | GA
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Zip | 30002-1146
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Country | US
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Telephone | 912-856-2951
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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 | APC007400
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License Number State | GA
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