=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588208557
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA JOHNSON HUGHES LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2019
-----------------------------------------------------
Last Update Date | 02/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 S WILKINSON ST STE 8
-----------------------------------------------------
City | MILLEDGEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31061-3352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-484-9722
-----------------------------------------------------
Fax | 478-721-6822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 342 LOG CABIN RD NE APT 1A
-----------------------------------------------------
City | MILLEDGEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31061-6517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-484-9722
-----------------------------------------------------
Fax | 478-721-6822
-----------------------------------------------------
=====================================================
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 | LPC010988
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LPC010988
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------