=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114275989
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YLONDA N HADLEY LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2012
-----------------------------------------------------
Last Update Date | 01/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8455 HIGHWAY 85 BLDG 200 SUITE A3
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30274-5115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-778-9567
-----------------------------------------------------
Fax | 678-817-3961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8250 LAVISTA CT
-----------------------------------------------------
City | RIVERDALE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30274-5188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-817-3961
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 005437
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------