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General NPI Number Information
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NPI Number | 1710517073
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Entity Type | Individual
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Provider Name | NADYA CLONTZ LAPC
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Gender | Female
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 4411 SUWANEE DAM RD STE 450
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City | SUWANEE
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State | GA
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Zip | 30024-8706
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Country | US
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Telephone | 770-331-6592
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Fax |
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Provider Business Mailing Address
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Address Line | 801 OLD PEACHTREE RD NW UNIT 24
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-3316
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Country | US
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Telephone | 770-883-8768
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | APC006803
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License Number State | GA
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