MEDICARE: CICERO LATIMORE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	002912	GA

General Provider Information

NPI Number	:	1023296662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CICERO LATIMORE LPC

Provider Business Mailing Address
First Line	:	940 HIGHWAY 96
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093
Country	:	US
Telephone Number	:	478-988-1222
Fax Number	:	478-988-1106

Provider Business Practice Location Address
First Line	:	940 GA HIGHWAY 96
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2584
Country	:	US
Telephone Number	:	478-988-1222
Fax Number	:	478-988-1106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	02/06/2008

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Directions to “ CICERO LATIMORE LPC” Practice Location

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