Provider Demographics
NPI:1003354705
Name:PETRONELLA, BETHANY ROSE ANN (LPC)
Entity Type:Individual
Prefix:
First Name:BETHANY ROSE
Middle Name:ANN
Last Name:PETRONELLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BETHANY ROSE
Other - Middle Name:ANN
Other - Last Name:KINZEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1303 HIGHTOWER TRL
Mailing Address - Street 2:230
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2962
Mailing Address - Country:US
Mailing Address - Phone:678-395-7922
Mailing Address - Fax:678-954-6589
Practice Address - Street 1:1303 HIGHTOWER TRL
Practice Address - Street 2:230
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-2962
Practice Address - Country:US
Practice Address - Phone:678-395-7922
Practice Address - Fax:678-954-6589
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional