Provider Demographics
NPI:1275836652
Name:SIMPSON, KATRINA L (LPC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:L
Last Name:SIMPSON
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 1:4349 BARRINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4935
Mailing Address - Country:US
Mailing Address - Phone:478-960-5456
Mailing Address - Fax:
Practice Address - Street 1:4349 BARRINGTON PL
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4935
Practice Address - Country:US
Practice Address - Phone:478-960-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional