Healthcare Provider Details

I. General information

NPI: 1386134575
Provider Name (Legal Business Name): SUSAN BAUMANN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 PRIOR ST NE
GAINESVILLE GA
30501-3441
US

IV. Provider business mailing address

430 PRIOR ST NE
GAINESVILLE GA
30501-3441
US

V. Phone/Fax

Practice location:
  • Phone: 678-971-5355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC010194
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010194
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: