Healthcare Provider Details

I. General information

NPI: 1144654328
Provider Name (Legal Business Name): MARCUS ANTHONY PREVETTE LPC, NCC, CST, CPCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2013
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SENORA PL
MACON GA
31210-1582
US

IV. Provider business mailing address

121 SENORA PL
MACON GA
31210-1582
US

V. Phone/Fax

Practice location:
  • Phone: 478-370-8476
  • Fax: 888-798-7392
Mailing address:
  • Phone: 478-370-8476
  • Fax: 888-798-7392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC009044
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC009044
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC003956
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009044
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC12181PC
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC12181PC
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC12181PC
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: