MEDICARE: MS. COLLEEN ELIZABETH WALSH 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	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	LPC009095	GA

General Provider Information

NPI Number	:	1245777952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLLEEN ELIZABETH WALSH LPC

Provider Business Mailing Address
First Line	:	4480H S COBB DR SE # 258
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6958
Country	:	US
Telephone Number	:	404-480-2038
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 WHITLOCK AVE SW
Second Line	:	SUITE C28
City	:	MARIETTA
State	:	GA
Zip	:	30064-4655
Country	:	US
Telephone Number	:	404-480-2038
Fax Number	:

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

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	07/05/2024

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