Provider Demographics
NPI:1073874038
Name:MYERS, LAVINIA DOWLING (LPC)
Entity Type:Individual
Prefix:
First Name:LAVINIA
Middle Name:DOWLING
Last Name:MYERS
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 1:2560 OAKWOOD TRCE SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8291
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4985-B LOWER ROSWELL RD
Practice Address - Street 2:STE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068
Practice Address - Country:US
Practice Address - Phone:770-508-0994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006517101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional