Provider Demographics
NPI:1720802572
Name:ALAM, MOSAMMAT FARIDA (LPC)
Entity type:Individual
Prefix:
First Name:MOSAMMAT
Middle Name:FARIDA
Last Name:ALAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3906
Mailing Address - Country:US
Mailing Address - Phone:347-351-0471
Mailing Address - Fax:
Practice Address - Street 1:602 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-3906
Practice Address - Country:US
Practice Address - Phone:347-351-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty