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General NPI Number Information
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NPI Number | 1497955876
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Entity Type | Organization
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Legal Business Name | PATTI L MEADOR
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 285 S PERRY ST
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-4840
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Country | US
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Telephone | 770-597-2158
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Fax |
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Provider Business Mailing Address
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Address Line | 1254 MAPLE DR SW
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City | LILBURN
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State | GA
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Zip | 30047-5531
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Country | US
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Telephone | 770-717-9833
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATTI L MEADOR
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Credential | RN, LPC
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Telephone | 770-597-2158
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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 | LPC004794
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License Number State | GA
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