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General NPI Number Information
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NPI Number | 1811408628
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Entity Type | Individual
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Provider Name | ASHLEY MAJESTA MAGISTRO LPC
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Gender | Female
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 101 QUARTZ DR STE 103A
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City | VILLA RICA
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State | GA
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Zip | 30180-3201
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Country | US
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Telephone | 770-812-8863
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Fax |
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Provider Business Mailing Address
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Address Line | 18 SHILOH CHURCH RD
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City | TAYLORSVILLE
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State | GA
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Zip | 30178-1551
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Country | US
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Telephone | 770-778-6851
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC009834
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License Number State | GA
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