MEDICARE: MS. GERMAINE MARIA ALDERSON M.S. 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	1016	WY
2	106H00000X	Marriage & Family Therapist	IMF 37866	CA
3	101YM0800X	Mental Health Counselor	011216	GA

General Provider Information

NPI Number	:	1083703458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GERMAINE MARIA ALDERSON M.S. LPC

Provider Business Mailing Address
First Line	:	3813 LOYOLA CT
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-5534
Country	:	US
Telephone Number	:	702-588-9606
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 GWINNETT DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-8444
Country	:	US
Telephone Number	:	678-209-2394
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	06/08/2020

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