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General NPI Number Information
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NPI Number | 1861153116
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Entity Type | Individual
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Provider Name | ANDRE HADLEY MARRIA LPC, CPCS
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Gender | Female
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 102 ROYAL AVE
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City | THOMASVILLE
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State | GA
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Zip | 31792-5233
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Country | US
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Telephone | 229-221-7230
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Fax | 772-236-0954
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Provider Business Mailing Address
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Address Line | PO BOX 3103
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City | THOMASVILLE
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State | GA
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Zip | 31799-3103
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Country | US
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Telephone | 229-221-7230
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Fax | 229-236-0954
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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 | 000552
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License Number State | GA
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