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General NPI Number Information
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NPI Number | 1265597165
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Entity Type | Individual
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Provider Name | MONETA HUDDLESTON SINCLAIR MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 977 TAYLOR ST SW SUITE A
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City | CONYERS
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State | GA
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Zip | 30012-5357
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Country | US
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Telephone | 770-918-6677
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Fax | 770-918-6686
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Provider Business Mailing Address
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Address Line | 1113 PALMER TRL
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City | LITHONIA
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State | GA
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Zip | 30058-9093
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Country | US
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Telephone | 678-793-0053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC04656
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License Number State | GA
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