Healthcare Provider Details

I. General information

NPI: 1962473322
Provider Name (Legal Business Name): DANA BALDWIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NORTH AVE
ATHENS GA
30601-2244
US

IV. Provider business mailing address

3699 BAXLEY RIDGE DR
SUWANEE GA
30024-4505
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-9739
  • Fax:
Mailing address:
  • Phone: 470-705-9848
  • Fax: 888-531-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC000933
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004819
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: