Provider Demographics
NPI:1528532421
Name:ATLAZOVA, DESISLAVA GEORGIEVA (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:DESISLAVA
Middle Name:GEORGIEVA
Last Name:ATLAZOVA
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 8TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1968
Mailing Address - Country:US
Mailing Address - Phone:985-807-1676
Mailing Address - Fax:985-400-2345
Practice Address - Street 1:2140 8TH ST STE 205
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1968
Practice Address - Country:US
Practice Address - Phone:985-807-1676
Practice Address - Fax:985-400-2345
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6011101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional