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NPI Code Detail

MEDICARE: MISS LAXANDERIA DAWN ROVER LPC

MEDICARE: MISS LAXANDERIA DAWN ROVER 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
1101YM0800XMental Health CounselorLAPC1057GA
2101YP2500XProfessional CounselorLPC005258GA

General Provider Information

NPI Number : 1851562508
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LAXANDERIA DAWN ROVER LPC
Provider Business Mailing Address
First Line : 548 WOODLAND PARK TER
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30043-1420
Country : US
Telephone Number : 678-336-9790
Fax Number :
Provider Business Practice Location Address
First Line : 1919 JOHN WESLEY AVE
Second Line :
City : COLLEGE PARK
State : GA
Zip : 30337-3605
Country : US
Telephone Number : 404-762-9190
Fax Number : 404-762-9101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2008
Last Update Date : 02/26/2013

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Directions to “ MISS LAXANDERIA DAWN ROVER LPC” Practice Location

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