Healthcare Provider Details

I. General information

NPI: 1588007900
Provider Name (Legal Business Name): BETTY JEANE EXUME LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 LOCKS WAY CT
MARTINEZ GA
30907-4965
US

IV. Provider business mailing address

781 LOCKS WAY CT
MARTINEZ GA
30907-4965
US

V. Phone/Fax

Practice location:
  • Phone: 706-951-6863
  • Fax: 706-868-9022
Mailing address:
  • Phone: 706-951-6863
  • Fax: 706-868-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number004479
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: