MEDICARE: ANTOINETTE BYNUM LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LPC014701	GA

General Provider Information

NPI Number	:	1083431274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE BYNUM LPC

Provider Business Mailing Address
First Line	:	1824 TIMBERLANE RD
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-2138
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1371 ORCHARD HILL RD
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-2551
Country	:	US
Telephone Number	:	478-445-4817
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2024
Last Update Date	:	09/20/2024

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Directions to “ ANTOINETTE BYNUM LPC” Practice Location

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