=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114230372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH M STAPP MA, LPC, NCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2010
-----------------------------------------------------
Last Update Date | 07/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 76 SANDCASTLE CT
-----------------------------------------------------
City | DAWSONVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30534-7075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-974-3899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2017
-----------------------------------------------------
City | DAWSONVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30534-0036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-974-3899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LPC-004711
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC-004711
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------