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General NPI Number Information
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NPI Number | 1659590057
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Entity Type | Individual
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Provider Name | STEPHEN MAYO MACGREGOR M.A. LMHC
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Gender | Male
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 6 MATHIAS DR.
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City | ROME
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State | GA
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Zip | 30165-7015
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Country | US
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Telephone | 941-258-3144
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Fax |
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Provider Business Mailing Address
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Address Line | 215 ROLLINGWOOD CIRCLE N.W.
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City | ROME
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State | GA
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Zip | 30165-1748
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Country | US
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Telephone | 941-268-3685
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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 | MH8247
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License Number State | FL
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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 | LPC007208
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License Number State | GA
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