Provider Demographics
NPI:1366659815
Name:REFOUR, MARIANETTE L (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MARIANETTE
Middle Name:L
Last Name:REFOUR
Suffix:
Gender:F
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 1:1251 MUIRFOREST LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3244
Mailing Address - Country:US
Mailing Address - Phone:404-668-4471
Mailing Address - Fax:
Practice Address - Street 1:3110 CLIFTON SPRINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4600
Practice Address - Country:US
Practice Address - Phone:404-243-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005098101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582104166OtherTAX ID NUMBER
GA582104166OtherTAX ID NUMBER