=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629168752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEJANDRA NARINO KLOPSTOCK MS, CRC, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2470 WINDY HILL RD SE SUITE 319-B
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30067-8613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-933-5367
-----------------------------------------------------
Fax | 404-812-1793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2470 WINDY HILL ROAD SUITE 319-B
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-933-5367
-----------------------------------------------------
Fax | 404-812-1793
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 003472
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------