Provider Demographics
NPI:1245777259
Name:BARCLAY, IVAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:
Last Name:BARCLAY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4942 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3935
Mailing Address - Country:US
Mailing Address - Phone:678-768-8502
Mailing Address - Fax:
Practice Address - Street 1:4942 LARKSPUR LN
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-3935
Practice Address - Country:US
Practice Address - Phone:678-768-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional