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General NPI Number Information
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NPI Number | 1538303201
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Entity Type | Individual
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Provider Name | KATHLEEN E BAZILE PH.D., LPC
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Gender | Female
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Dates
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Enumeration Date | 04/26/2009
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 1900 THE EXCHANGE SE STE 100
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City | ATLANTA
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State | GA
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Zip | 30339-2022
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Country | US
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Telephone | 470-231-6178
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 191321
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City | ATLANTA
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State | GA
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Zip | 31119-1321
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Country | US
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Telephone | 407-529-8289
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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 | LPC008451
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License Number State | GA
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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 | LPC008451
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License Number State | GA
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