MEDICARE: JO-ANNE T LIAKAKOS LPC, NCC

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	005963	GA

General Provider Information

NPI Number	:	1073813820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO-ANNE T LIAKAKOS LPC, NCC

Provider Business Mailing Address
First Line	:	15455 ALPHA WOODS DR
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30004-2834
Country	:	US
Telephone Number	:	770-265-1971
Fax Number	:

Provider Business Practice Location Address
First Line	:	11815 NORTHFALL LN
Second Line	:	SUITE 1006
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-7973
Country	:	US
Telephone Number	:	770-265-1971
Fax Number	:

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

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	12/08/2010

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