Provider Demographics
NPI:1073852950
Name:COLRAIN, JOANNA (LPC, CGP)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:
Last Name:COLRAIN
Suffix:
Gender:F
Credentials:LPC, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2543
Mailing Address - Country:US
Mailing Address - Phone:770-220-4059
Mailing Address - Fax:
Practice Address - Street 1:150 E PONCE DE LEON AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2543
Practice Address - Country:US
Practice Address - Phone:770-220-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional