Provider Demographics
NPI:1609050145
Name:MASON, WENDY JEAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:JEAN
Last Name:MASON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RT 3 BOX 227A
Mailing Address - Street 2:
Mailing Address - City:SOPERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30457
Mailing Address - Country:US
Mailing Address - Phone:478-595-2675
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 227A
Practice Address - Street 2:
Practice Address - City:SOPERTON
Practice Address - State:GA
Practice Address - Zip Code:30457-9344
Practice Address - Country:US
Practice Address - Phone:478-595-2675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional