Healthcare Provider Details

I. General information

NPI: 1649934407
Provider Name (Legal Business Name): JOSEPH HUGH ETHEREDGE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 SHARPSBURG MCCULLUM RD STE 105
NEWNAN GA
30265-2297
US

IV. Provider business mailing address

153 GRIZZLY TRL
CARROLLTON GA
30117-4974
US

V. Phone/Fax

Practice location:
  • Phone: 678-423-5500
  • Fax:
Mailing address:
  • Phone: 470-729-0987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014279
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: