Provider Demographics
NPI:1497955876
Name:PATTI L MEADOR
Entity Type:Organization
Organization Name:PATTI L MEADOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEADOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LPC
Authorized Official - Phone:770-597-2158
Mailing Address - Street 1:1254 MAPLE DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5531
Mailing Address - Country:US
Mailing Address - Phone:770-717-9833
Mailing Address - Fax:
Practice Address - Street 1:285 S PERRY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-4840
Practice Address - Country:US
Practice Address - Phone:770-597-2158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty