Provider Demographics
NPI:1164827986
Name:CONN, LAURA (LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CONN
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 1:410 E TAYLOR ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-3442
Mailing Address - Country:US
Mailing Address - Phone:770-233-2809
Mailing Address - Fax:770-233-2810
Practice Address - Street 1:410 E TAYLOR ST
Practice Address - Street 2:SUITE H
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-3442
Practice Address - Country:US
Practice Address - Phone:770-233-2809
Practice Address - Fax:770-233-2810
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health