Provider Demographics
NPI:1164191128
Name:MORRIS, GENEVIEVE M (LPC, MATS)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:M
Last Name:MORRIS
Suffix:
Gender:F
Credentials:LPC, MATS
Other - Prefix:
Other - First Name:GENNA
Other - Middle Name:MARIE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, MATS
Mailing Address - Street 1:1201 CARMINE CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4006
Mailing Address - Country:US
Mailing Address - Phone:678-723-5171
Mailing Address - Fax:
Practice Address - Street 1:401 WESTPARK CT STE 200
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3572
Practice Address - Country:US
Practice Address - Phone:678-492-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012366101YA0400X, 101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC012366OtherSTATE LICENSURE