Provider Demographics
NPI:1568131019
Name:HUFFSTEAD, MARY E (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:HUFFSTEAD
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 THOMAS NEWELL WAY UNIT 1106
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-2560
Mailing Address - Country:US
Mailing Address - Phone:219-487-9215
Mailing Address - Fax:
Practice Address - Street 1:555 SUN VALLEY DR STE L3
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5630
Practice Address - Country:US
Practice Address - Phone:678-395-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010611101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional