Provider Demographics
NPI:1568257897
Name:PROFACI, MARBELLA
Entity type:Individual
Prefix:
First Name:MARBELLA
Middle Name:
Last Name:PROFACI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 W OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7369
Mailing Address - Country:US
Mailing Address - Phone:470-338-9254
Mailing Address - Fax:
Practice Address - Street 1:500 SUGAR MILL RD STE 100A
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-6438
Practice Address - Country:US
Practice Address - Phone:770-771-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health