Healthcare Provider Details

I. General information

NPI: 1689107906
Provider Name (Legal Business Name): DEIRDRE GUEST LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 IVY HILL DR
BUFORD GA
30519-7922
US

IV. Provider business mailing address

2775 IVY HILL DR
BUFORD GA
30519-7922
US

V. Phone/Fax

Practice location:
  • Phone: 718-971-4889
  • Fax:
Mailing address:
  • Phone: 718-971-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00973400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007167-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC012895
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: