Provider Demographics
NPI:1114467297
Name:MAXWELL, PAULINE (LPC)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:MAXWELL
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 1:111 S MONROE ST APT C
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39817-4058
Mailing Address - Country:US
Mailing Address - Phone:229-220-7348
Mailing Address - Fax:
Practice Address - Street 1:111 S MONROE ST APT C
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-4058
Practice Address - Country:US
Practice Address - Phone:229-220-7348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional