Provider Demographics
NPI:1962029702
Name:HARIANAWALA, FATEMA SHABBIR (LPC)
Entity type:Individual
Prefix:
First Name:FATEMA
Middle Name:SHABBIR
Last Name:HARIANAWALA
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 1:151 HIGHWAY 74 S UNIT 3437
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4317
Mailing Address - Country:US
Mailing Address - Phone:678-310-4789
Mailing Address - Fax:
Practice Address - Street 1:120 HANDLEY RD STE 310
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2173
Practice Address - Country:US
Practice Address - Phone:678-310-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty