Provider Demographics
NPI:1104835867
Name:HARTIG, YVONNE DYKES (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:DYKES
Last Name:HARTIG
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FORREST DR
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-3550
Mailing Address - Country:US
Mailing Address - Phone:478-825-7153
Mailing Address - Fax:478-953-2060
Practice Address - Street 1:100 KATELYN CIR
Practice Address - Street 2:SUITE B
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6481
Practice Address - Country:US
Practice Address - Phone:478-953-2122
Practice Address - Fax:478-953-2060
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC000473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional