Provider Demographics
NPI:1063653145
Name:FARMER, DUANE T (LPC)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:T
Last Name:FARMER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 CANTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3616
Mailing Address - Country:US
Mailing Address - Phone:770-552-0717
Mailing Address - Fax:
Practice Address - Street 1:1175 CANTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3616
Practice Address - Country:US
Practice Address - Phone:770-552-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional