Provider Demographics
NPI:1063779882
Name:FRAIJO-PAUL, LARAINE NICOLE (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:LARAINE
Middle Name:NICOLE
Last Name:FRAIJO-PAUL
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BATES AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1301
Mailing Address - Country:US
Mailing Address - Phone:706-399-6591
Mailing Address - Fax:
Practice Address - Street 1:1986 HOSEA L WILLIAMS DR NE STE C
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2225
Practice Address - Country:US
Practice Address - Phone:706-399-6591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006785101YP2500X
GALPC006785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional