Provider Demographics
NPI:1376229740
Name:HARLEY, JUSTIN (LPC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:HARLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 DARWISH DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-3624
Mailing Address - Country:US
Mailing Address - Phone:404-513-5231
Mailing Address - Fax:
Practice Address - Street 1:224 DARWISH DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-3624
Practice Address - Country:US
Practice Address - Phone:404-513-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004871101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor