Provider Demographics
NPI:1871776278
Name:BARR, AZADEH (LPC)
Entity type:Individual
Prefix:
First Name:AZADEH
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:NILLY
Other - Middle Name:
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:101 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-1631
Mailing Address - Country:US
Mailing Address - Phone:864-271-2740
Mailing Address - Fax:864-271-8712
Practice Address - Street 1:101 E PARK AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-1631
Practice Address - Country:US
Practice Address - Phone:864-271-2740
Practice Address - Fax:864-271-8712
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional