Provider Demographics
NPI:1619293685
Name:TOWLER, TARA VETTENA (LPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:VETTENA
Last Name:TOWLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1011 HARBINS RD
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-2405
Mailing Address - Country:US
Mailing Address - Phone:404-580-7150
Mailing Address - Fax:770-676-9133
Practice Address - Street 1:6810 ROSWELL ROAD
Practice Address - Street 2:SUITE 2B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:404-580-7150
Practice Address - Fax:770-676-9133
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPC005795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional