Healthcare Provider Details

I. General information

NPI: 1689146730
Provider Name (Legal Business Name): LAVERNE WARE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2883 BAKER RIDGE DR NW
ATLANTA GA
30318-7257
US

IV. Provider business mailing address

2451 CUMBERLAND PKWY SE STE 3667
ATLANTA GA
30339-6136
US

V. Phone/Fax

Practice location:
  • Phone: 404-558-8750
  • Fax:
Mailing address:
  • Phone: 404-438-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004950
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: