Individual
MR. FRED MATTHEW FARRAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC , NCC
Contact information
Practice address
98 GORDON COMMERCIAL DR, LAGRANGE, GA 30240-5735
(706) 837-0045
(706) 837-0035
Mailing address
PO BOX 4078, LAGRANGE, GA 30241-0082
(706) 837-0045
(706) 837-0035
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
271261
GA
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
005914
GA
Other
Enumeration date
01/12/2012
Last updated
01/12/2012
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