Provider Demographics
NPI:1275236580
Name:BOOTH, MARGUERITE SPIOTTA (LPC)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:SPIOTTA
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARGUERITE
Other - Middle Name:REID
Other - Last Name:SPIOTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 NORTHCUTT ST SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3228
Mailing Address - Country:US
Mailing Address - Phone:404-909-6636
Mailing Address - Fax:
Practice Address - Street 1:3560 LENOX RD NE STE 1230
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-4335
Practice Address - Country:US
Practice Address - Phone:404-909-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional