Healthcare Provider Details

I. General information

NPI: 1447870167
Provider Name (Legal Business Name): NATASHA M PATTERSON LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 QUIET WATERS LN
LAWRENCEVILLE GA
30045-7069
US

IV. Provider business mailing address

PO BOX 4
LAWRENCEVILLE GA
30046-9998
US

V. Phone/Fax

Practice location:
  • Phone: 678-477-8672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010158
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number681550
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: