Provider Demographics
NPI:1346500659
Name:EARWOOD, TINA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:EARWOOD
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 1:7951 MCKEE RD
Mailing Address - Street 2:
Mailing Address - City:UPATOI
Mailing Address - State:GA
Mailing Address - Zip Code:31829-1720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7951 MCKEE RD
Practice Address - Street 2:
Practice Address - City:UPATOI
Practice Address - State:GA
Practice Address - Zip Code:31829-1720
Practice Address - Country:US
Practice Address - Phone:706-593-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006825101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health