Provider Demographics
NPI:1346563418
Name:NEWSOME, CARLEEN MARIE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CARLEEN
Middle Name:MARIE
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 OLD ALABAMA RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8593
Mailing Address - Country:US
Mailing Address - Phone:770-667-8844
Mailing Address - Fax:
Practice Address - Street 1:2750 OLD ALABAMA RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8593
Practice Address - Country:US
Practice Address - Phone:770-667-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006168101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional