MEDICARE: MS. COLLEEN P PANUNZIO MA,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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	101YP2500X	Professional Counselor	003201	GA
4	101Y00000X	Counselor

General Provider Information

NPI Number	:	1821080102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLLEEN P PANUNZIO MA,LPC

Provider Business Mailing Address
First Line	:	251 RIVER PARK NORTH DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-7835
Country	:	US
Telephone Number	:	678-557-5996
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 RIVER PARK NORTH DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-7835
Country	:	US
Telephone Number	:	678-557-5996
Fax Number	:

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	08/05/2025

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