Doctor Name: | MRS. AMY E. FRADY |
NPI Number: | 1205022357 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LPC, NCC |
License Number: | LPC004690 |
Business Practice Address: | 156 Level Grove Rd Cornelia, GA - 305313273 |
Business Phone Number: | 6789360474 |
Business Fax Number: | |
Mailing Address: | Po Box 1064, LULA |
State: | GA |
Postal Code: | 305541064 |
Phone Number: | 6789360474 |
Fax Number: | |
NPI Enumeration Date: | 09/22/2007 |
NPI Last Update Date: | 09/22/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC004690 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |