Provider Demographics
NPI:1043754583
Name:NANCE, ANNA (LPC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:NANCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 MURRY PARK
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2622
Mailing Address - Country:US
Mailing Address - Phone:404-960-1282
Mailing Address - Fax:855-817-2428
Practice Address - Street 1:820 EBENEZER CHURCH RD STE 110
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-2073
Practice Address - Country:US
Practice Address - Phone:404-960-1282
Practice Address - Fax:855-817-2428
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004934101YM0800X
GALPC007649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health