Provider Demographics
NPI:1053569681
Name:WEATHERS, AVRIL L'MOUR (PHD)
Entity type:Individual
Prefix:DR
First Name:AVRIL
Middle Name:L'MOUR
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56025
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30343-0025
Mailing Address - Country:US
Mailing Address - Phone:404-567-4272
Mailing Address - Fax:
Practice Address - Street 1:400 NORTHSIDE DR NW
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-7023
Practice Address - Country:US
Practice Address - Phone:404-567-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171W00000X
IL27005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171W00000XOther Service ProvidersContractor