Individual
NICKESHA CHRISTINE AZAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
400 CHURCHILL CT STE 440, WOODSTOCK, GA 30188-6871
(202) 384-2875
Mailing address
400 CHURCHILL CT STE 440, WOODSTOCK, GA 30188-6871
(202) 384-2875
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
83024
CA
1041C0700X
Clinical Social Worker
Primary
CSW009076
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/19/2017
Last updated
04/24/2024
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