Healthcare Provider Details

I. General information

NPI: 1588780357
Provider Name (Legal Business Name): HEATHER LAWRY ROESNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 FANT DR
FORT OGLETHORPE GA
30742-3307
US

IV. Provider business mailing address

PO BOX 1027
LA FAYETTE GA
30728-1027
US

V. Phone/Fax

Practice location:
  • Phone: 706-806-1273
  • Fax: 706-806-1109
Mailing address:
  • Phone: 706-670-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC005672
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: