Provider Demographics
NPI:1154812220
Name:OSWIN, SOPHIE LAKE (LPC, MA)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:LAKE
Last Name:OSWIN
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:MRS
Other - First Name:SOPHIE
Other - Middle Name:MONIGATTI
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAPC
Mailing Address - Street 1:7155 SOUTHFACE WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-6364
Mailing Address - Country:US
Mailing Address - Phone:530-913-8900
Mailing Address - Fax:
Practice Address - Street 1:1820 THE EXCHANGE SE STE 550
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2088
Practice Address - Country:US
Practice Address - Phone:530-913-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012836101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional