Healthcare Provider Details

I. General information

NPI: 1063299501
Provider Name (Legal Business Name): LARVITTA SHAWNET BAILEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ALTMORE AVE STE 200
SANDY SPRINGS GA
30342-2495
US

IV. Provider business mailing address

7413 CHASTAIN DR NE
ATLANTA GA
30342-4184
US

V. Phone/Fax

Practice location:
  • Phone: 770-282-7123
  • Fax:
Mailing address:
  • Phone: 770-231-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014231
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: