Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC007858 | GA |
NPI | 1003399718 |
---|---|
Provider Name | Phillip Zaffos |
First Address | Marietta, GA 30064-2597 |
Second Address | Marietta, GA 30064-2597 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2018 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14326648 | CAQH (01) |