Provider Demographics
NPI:1619273935
Name:O'CONNOR, NANCY W (LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:W
Last Name:O'CONNOR
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 1:208 LONGLEAF CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-1701
Mailing Address - Country:US
Mailing Address - Phone:478-451-9833
Mailing Address - Fax:
Practice Address - Street 1:175 EMERY HWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3692
Practice Address - Country:US
Practice Address - Phone:478-751-4519
Practice Address - Fax:478-751-4530
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003521OtherLPC