Healthcare Provider Details

I. General information

NPI: 1689831448
Provider Name (Legal Business Name): LINDA C WEIGAND LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 GOVERNORS SQ STE A
FAYETTEVILLE GA
30215-4861
US

IV. Provider business mailing address

145 GOVERNORS SQ STE A
FAYETTEVILLE GA
30215-4861
US

V. Phone/Fax

Practice location:
  • Phone: 678-364-1300
  • Fax: 678-364-1352
Mailing address:
  • Phone: 678-364-1300
  • Fax: 678-364-1352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC003094
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: