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NPI Code Detail

MEDICARE: GERA IRVINE LPC

MEDICARE:   GERA  IRVINE  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
1101YP2500XProfessional CounselorLPC3186GA

General Provider Information

NPI Number : 1346691540
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERA IRVINE LPC
Provider Business Mailing Address
First Line : 2278 MOODY RD STE D
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-1933
Country : US
Telephone Number : 478-929-0294
Fax Number : 478-923-9770
Provider Business Practice Location Address
First Line : 2278 MOODY RD STE D
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-1933
Country : US
Telephone Number : 478-929-0294
Fax Number : 478-923-9770
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2016
Last Update Date : 05/07/2026

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Directions to “ GERA IRVINE LPC” Practice Location

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