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General NPI Number Information
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NPI Number | 1548758824
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Entity Type | Individual
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Provider Name | MATTHEW BESTIC LPC
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Gender | Male
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 884 LEGACY PARK DR STE 302
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8760
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Country | US
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Telephone | 770-626-5302
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Fax |
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Provider Business Mailing Address
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Address Line | 2542 MEADOWGLEN TRL
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City | SNELLVILLE
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State | GA
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Zip | 30078-2274
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Country | US
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Telephone | 678-471-4851
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APC005684
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC012469
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License Number State | GA
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