Provider Demographics
NPI:1477179315
Name:GEORGEN, FREDNA LEIGH (MAPC, LPC)
Entity Type:Individual
Prefix:
First Name:FREDNA
Middle Name:LEIGH
Last Name:GEORGEN
Suffix:
Gender:F
Credentials:MAPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HIGHWAY 469 N
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-8928
Mailing Address - Country:US
Mailing Address - Phone:601-966-2847
Mailing Address - Fax:
Practice Address - Street 1:615 HIGHWAY 469 N
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-8928
Practice Address - Country:US
Practice Address - Phone:601-966-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2549101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health