Provider Demographics
NPI:1235193475
Name:HASTINGS, ALYCE A (LPC, MAC, CTS)
Entity Type:Individual
Prefix:
First Name:ALYCE
Middle Name:A
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:LPC, MAC, CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 STIRRATT RD
Mailing Address - Street 2:
Mailing Address - City:RANGER
Mailing Address - State:GA
Mailing Address - Zip Code:30734-7762
Mailing Address - Country:US
Mailing Address - Phone:706-334-4185
Mailing Address - Fax:706-334-6969
Practice Address - Street 1:4015 S COBB DR SE
Practice Address - Street 2:220
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6303
Practice Address - Country:US
Practice Address - Phone:404-374-0704
Practice Address - Fax:770-435-5740
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003418101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor