Individual
LISA GAIL RUDESEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
175 EMERY HWY, MACON, GA 31217-3692
(478) 751-4446
(478) 751-4530
Mailing address
175 EMERY HWY, MACON, GA 31217-3692
(478) 751-4446
(478) 751-4530
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
002130
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002130
LPC
GA
Enumeration date
11/06/2009
Last updated
11/06/2009
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