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General NPI Number Information
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NPI Number | 1639536535
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Entity Type | Individual
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Provider Name | JUSTIN PAUL LEDFORD COUNSELOR
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Gender | Male
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 1900 THE EXCHANGE SE STE 100
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City | ATLANTA
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State | GA
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Zip | 30339-2022
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Country | US
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Telephone | 404-233-3949
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Fax |
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Provider Business Mailing Address
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Address Line | 1081 CANTERBURY DR SE
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City | SMYRNA
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State | GA
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Zip | 30082-4201
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Country | US
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Telephone | 404-502-4702
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3566
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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 |
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License Number State | GA
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