Individual
MR. MYRON RUSSELL PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC, LMSW
Contact information
Practice address
201 N MAIN ST, LA FAYETTE, GA 30728-2419
(678) 590-5589
Mailing address
121 LAZY OAK TRL, RINGGOLD, GA 30736-5573
(423) 785-7391
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0527
GA
104100000X
Social Worker
Primary
MSW011227
GA
Other
Enumeration date
11/18/2019
Last updated
08/21/2023
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