Provider Demographics
NPI:1316747363
Name:OTUATA, SYDNEY (MS, LAPC, NCC)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:OTUATA
Suffix:
Gender:
Credentials:MS, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 PARK NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-6200
Mailing Address - Country:US
Mailing Address - Phone:404-943-1070
Mailing Address - Fax:678-691-2124
Practice Address - Street 1:815 PARK NORTH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-6200
Practice Address - Country:US
Practice Address - Phone:404-943-1070
Practice Address - Fax:678-691-2124
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health