=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013386861
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NANCY PAULK MOBLEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2015
-----------------------------------------------------
Last Update Date | 09/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 584 ARLINGTON PL
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31201-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-743-1472
-----------------------------------------------------
Fax | 478-743-1472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 584 ARLINGTON PL
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31201-1705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-743-1472
-----------------------------------------------------
Fax | 478-743-1472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | NANCY PAULK MOBLEY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 478-335-6948
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 003438
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------