Provider Demographics
NPI:1235402926
Name:EGBE, PAUL O (THERAPIST)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:O
Last Name:EGBE
Suffix:
Gender:M
Credentials:THERAPIST
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:ODEY
Other - Last Name:EGBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:PO BOX 2533
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-1737
Mailing Address - Country:US
Mailing Address - Phone:334-545-0582
Mailing Address - Fax:
Practice Address - Street 1:769 EMPORIA LOOP
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6904
Practice Address - Country:US
Practice Address - Phone:470-540-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-11
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3002101YM0800X, 101YP2500X
GALPC006777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health