Individual
PAGE ELGIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED, MS., LPC, RPT
Contact information
Practice address
435 2ND ST STE 206, MACON, GA 31201-8201
(713) 366-2914
Mailing address
522 CHERRY ST APT 301, MACON, GA 31201-6330
(713) 366-2914
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
76004
TX
101YM0800X
Mental Health Counselor
Primary
LPC011920
GA
Other
Enumeration date
04/05/2017
Last updated
09/18/2024
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