Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | LPC008089 | GA |
N | 101YM0800X | Mental Health Counselor | LPC008089 | GA |
N | 101YP1600X | Pastoral Counselor | LPC008089 | GA |
N | 101YP2500X | Professional Counselor | LPC008089 | GA |
NPI | 1245622752 |
---|---|
Provider Name | Mary Keller |
First Address | Mcdonough, GA 30253-4310 |
Second Address | Mcdonough, GA 30253-4310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2015 |
Last Update Date | 21/02/2015 |