Provider Demographics
NPI:1346922648
Name:LEDWITZ, MARNI SUSAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARNI
Middle Name:SUSAN
Last Name:LEDWITZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MARNI
Other - Middle Name:SUSAN
Other - Last Name:RUTENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1441 WOODMONT LN NW STE 844
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2866
Mailing Address - Country:US
Mailing Address - Phone:954-559-4444
Mailing Address - Fax:
Practice Address - Street 1:1550 SEAGRAPE WAY
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-4862
Practice Address - Country:US
Practice Address - Phone:195-455-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional