Provider Demographics
NPI:1003844275
Name:COSEY, PATRICIA W (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:W
Last Name:COSEY
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1811 GREEN CIR STE B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2784
Mailing Address - Country:US
Mailing Address - Phone:229-244-9688
Mailing Address - Fax:229-244-5354
Practice Address - Street 1:1811 GREEN CIR STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2784
Practice Address - Country:US
Practice Address - Phone:229-244-9688
Practice Address - Fax:229-244-5354
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003066101YP2500X
GA003066LPCGA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003150577AMedicaid