Healthcare Provider Details

I. General information

NPI: 1689897449
Provider Name (Legal Business Name): LEA HUNTER LPC,MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 OSBORNE ST
SAINT MARYS GA
31558-8410
US

IV. Provider business mailing address

605 OSBORNE ST
SAINT MARYS GA
31558-8410
US

V. Phone/Fax

Practice location:
  • Phone: 912-825-8488
  • Fax: 912-341-6794
Mailing address:
  • Phone: 912-825-8488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1920
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10081
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: