Healthcare Provider Details

I. General information

NPI: 1235496613
Provider Name (Legal Business Name): MEGAN EDGE VOREES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN EDGE

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 HIGHWAY 123
TOCCOA GA
30577-8686
US

IV. Provider business mailing address

PO BOX D
TOCCOA GA
30577-1448
US

V. Phone/Fax

Practice location:
  • Phone: 706-244-5159
  • Fax:
Mailing address:
  • Phone: 706-244-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC003089
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008382
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: