MEDICARE: MS. OLISA YAA AJINAKU LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC003694	GA

General Provider Information

NPI Number	:	1437392081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. OLISA YAA AJINAKU LPC

Provider Business Mailing Address
First Line	:	920 DANNON VIEW SUITE 3202
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331
Country	:	US
Telephone Number	:	404-346-3471
Fax Number	:	404-346-3473

Provider Business Practice Location Address
First Line	:	920 DANNON VW SW STE 3202
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2161
Country	:	US
Telephone Number	:	404-346-3471
Fax Number	:	404-346-3473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	04/13/2009

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