MEDICARE: DEIRDRE GUEST LMHC, 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	37PC00973400	NJ
2	101YM0800X	Mental Health Counselor	007167-1	NY
3	101YM0800X	Mental Health Counselor	LPC012895	GA

General Provider Information

NPI Number	:	1689107906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRE GUEST LMHC, LPC

Provider Business Mailing Address
First Line	:	2775 IVY HILL DR
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-7922
Country	:	US
Telephone Number	:	718-971-4889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 IVY HILL DR
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-7922
Country	:	US
Telephone Number	:	718-971-4889
Fax Number	:

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

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	06/01/2026

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