MEDICARE: MRS. LORENA SOARES LPC, NCC

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	101YP2500X	Professional Counselor	LPC007474	GA

General Provider Information

NPI Number	:	1902232283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORENA SOARES LPC, NCC

Provider Business Mailing Address
First Line	:	120 S PARK SQ NE
Second Line	:	SUITE 208
City	:	MARIETTA
State	:	GA
Zip	:	30060-8602
Country	:	US
Telephone Number	:	770-633-6503
Fax Number	:	678-290-6614

Provider Business Practice Location Address
First Line	:	120 S PARK SQ NE
Second Line	:	SUITE 208
City	:	MARIETTA
State	:	GA
Zip	:	30060-8602
Country	:	US
Telephone Number	:	770-633-6503
Fax Number	:	678-290-6614

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

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	07/22/2014

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