Individual
MR. RICHARD JOHN THAXTON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
3459 ACWORTH DUE WEST RD NW, ACWORTH, GA 30101-5819
(678) 587-8858
Mailing address
959 FAIRLONG DR NW, ACWORTH, GA 30101-7894
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC011689
GA
Other
Enumeration date
12/11/2017
Last updated
01/16/2024
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