Provider Demographics
NPI:1568786135
Name:ABBOTT, HERSCHEL LEE III (LPC, NCC, MED)
Entity Type:Individual
Prefix:MR
First Name:HERSCHEL
Middle Name:LEE
Last Name:ABBOTT
Suffix:III
Gender:M
Credentials:LPC, NCC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 LAKE COVE APPROACH
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-5932
Mailing Address - Country:US
Mailing Address - Phone:678-876-0424
Mailing Address - Fax:
Practice Address - Street 1:14 BROWN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-2031
Practice Address - Country:US
Practice Address - Phone:678-876-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005681101Y00000X
LA2577101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor