Provider Demographics
NPI:1124440938
Name:ORREGO, JOANNA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:ORREGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 POWDER SPRINGS ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:366 POWDER SPRINGS ST
Practice Address - Street 2:SUITE 212
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3424
Practice Address - Country:US
Practice Address - Phone:786-282-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12019101YM0800X
GALPC007580101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health