Individual provider Active NPI

Fatima Wasim, PH.D.

  • Counseling Psychologist
  • Roswell, GA
National Provider Identifier
1154849867
Registry record updated Jan 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
PSY004097 Issued in GA
Practice address
555 Sun Valley Dr Ste G4
Roswell, GA 30076-5607
Phone
(678) 235-5054
Fax
(678) 810-0666
NPI assigned
Sep 1, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Psychologist 103TH0100X 4956 NC
Counseling PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC1900X PSY004097 GA Primary
Psychologist 103T00000X PSY004097 GA

Addresses

Primary practice location

555 Sun Valley Dr Ste G4
Roswell, GA 30076-5607

Mailing address

4470 Mossbrook Cir
Alpharetta, GA 30004-4475
Phone (678) 313-2772

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
4956NCMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769385600000",
    "number": "1154849867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4470 MOSSBROOK CIR",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300044475",
            "telephone_number": "678-313-2772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 SUN VALLEY DR STE G4",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765607",
            "telephone_number": "678-235-5054",
            "fax_number": "678-810-0666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASIM",
        "first_name": "FATIMA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-01",
        "last_updated": "2026-01-26",
        "certification_date": "2026-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "NC",
            "license": "4956",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": "GA",
            "license": "PSY004097",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY004097",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.