Provider Demographics
NPI:1437362217
Name:MIDDLETON, TINA (LPC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 TRIUMPH DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1051
Mailing Address - Country:US
Mailing Address - Phone:706-681-5681
Mailing Address - Fax:
Practice Address - Street 1:202 TRIUMPH DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1051
Practice Address - Country:US
Practice Address - Phone:706-681-5681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005858101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional