Provider Demographics
NPI:1093977613
Name:DE JONGE, MAUREEN (RN, MA, LPC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:DE JONGE
Suffix:
Gender:F
Credentials:RN, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 HARNER RD
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2010
Mailing Address - Country:US
Mailing Address - Phone:478-213-0256
Mailing Address - Fax:478-213-0256
Practice Address - Street 1:101 OBRIEN DR
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-5337
Practice Address - Country:US
Practice Address - Phone:478-988-3188
Practice Address - Fax:478-988-3188
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC5955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional