Provider Demographics
NPI:1477044055
Name:STROUP, EMILY (LAPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:STROUP
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PLUM BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-5566
Mailing Address - Country:US
Mailing Address - Phone:770-833-3108
Mailing Address - Fax:
Practice Address - Street 1:2735 OLD ATLANTA RD STE A
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-7252
Practice Address - Country:US
Practice Address - Phone:770-833-3108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional