Provider Demographics
NPI:1407124043
Name:NAVARRE, MARY ANN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:NAVARRE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HANDLEY RD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2177
Mailing Address - Country:US
Mailing Address - Phone:404-409-9385
Mailing Address - Fax:
Practice Address - Street 1:120 HANDLEY RD
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2177
Practice Address - Country:US
Practice Address - Phone:404-409-9385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-11
Last Update Date:2011-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional