Provider Demographics
NPI:1346826930
Name:PEDEN, MARJORIE (LPC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:PEDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARGIE
Other - Middle Name:
Other - Last Name:PEDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1115 BIG HAYNES DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4903
Mailing Address - Country:US
Mailing Address - Phone:678-231-5014
Mailing Address - Fax:
Practice Address - Street 1:2208 MAIN ST E
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3498
Practice Address - Country:US
Practice Address - Phone:770-985-0837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional