Provider Demographics
NPI:1568731495
Name:LIVELY, TAMARA DAWN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:DAWN
Last Name:LIVELY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:DAWN
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 SEALS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-6761
Mailing Address - Country:US
Mailing Address - Phone:678-816-9050
Mailing Address - Fax:
Practice Address - Street 1:126 ENTERPRISE PATH
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2656
Practice Address - Country:US
Practice Address - Phone:678-896-8959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011146101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator