MEDICARE: CHRISTA POWELL RAINES 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	LPC004283	GA

General Provider Information

NPI Number	:	1467676916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA POWELL RAINES LPC, NCC

Provider Business Mailing Address
First Line	:	285 WHITNEY LN
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-7766
Country	:	US
Telephone Number	:	770-954-0917
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 HENRY PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6636
Country	:	US
Telephone Number	:	770-358-8530
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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