Healthcare Provider Details

I. General information

NPI: 1821009283
Provider Name (Legal Business Name): JUDY WEINER LMNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2479-B COASTAL HIGHWAY 17 S
RICHMOND HILL GA
31324
US

IV. Provider business mailing address

5 CAISSON XING
SAVANNAH GA
31411-1302
US

V. Phone/Fax

Practice location:
  • Phone: 912-756-4117
  • Fax: 912-756-4127
Mailing address:
  • Phone: 912-598-1988
  • Fax: 912-598-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number261
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004739
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number116
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: