MEDICARE: MAYA LEMBERG 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	LPC009954	GA

General Provider Information

NPI Number	:	1295215796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA LEMBERG LPC

Provider Business Mailing Address
First Line	:	636 PAULEY PL
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5222
Country	:	US
Telephone Number	:	770-310-2357
Fax Number	:

Provider Business Practice Location Address
First Line	:	4274 PEACHTREE RD NE STE 201
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-3015
Country	:	US
Telephone Number	:	770-310-2357
Fax Number	:

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

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	08/15/2018

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