Provider Demographics
NPI:1285009316
Name:CARSON, JUSTIN (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:CARSON
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E MAIN ST STE M
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2759
Mailing Address - Country:US
Mailing Address - Phone:470-361-9494
Mailing Address - Fax:
Practice Address - Street 1:270 E MAIN ST STE M
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2759
Practice Address - Country:US
Practice Address - Phone:470-361-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004781101YP2500X
GALPC010089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional