Individual
SANDRA RENEE KOOTSIKAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1105 W PEACHTREE ST NW, ATLANTA, GA 30309-3608
(678) 472-1820
Mailing address
1233 WOODLAND AVE NE, UNIT 2, ATLANTA, GA 30324-4542
(678) 472-1820
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC002570
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
251S0000X
ORGANIZATION TAXONOMY COD
GA
Enumeration date
06/11/2007
Last updated
07/08/2007
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