MEDICARE: MRS. VIRGINIA LOUISE PUCKETT 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	APC005224	GA
2	101YP2500X	Professional Counselor	LPC011970	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316433774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIRGINIA LOUISE PUCKETT LPC

Provider Business Mailing Address
First Line	:	126 ENTERPRISE PATH STE 205
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-2654
Country	:	US
Telephone Number	:	678-556-5166
Fax Number	:	678-556-5675

Provider Business Practice Location Address
First Line	:	126 ENTERPRISE PATH STE 205
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-2654
Country	:	US
Telephone Number	:	678-556-5166
Fax Number	:	678-556-5675

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	10/24/2025

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