Provider Demographics
NPI:1225202989
Name:BAYNE, MOLLY SUSAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:SUSAN
Last Name:BAYNE
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 1:2000 S PARK PL SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2013
Mailing Address - Country:US
Mailing Address - Phone:770-956-6472
Mailing Address - Fax:770-937-4126
Practice Address - Street 1:2000 S PARK PL SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2013
Practice Address - Country:US
Practice Address - Phone:770-956-6472
Practice Address - Fax:770-937-4126
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 004714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional