Provider Demographics
NPI:1629146261
Name:ROSE, MARGIE PUCKETT (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARGIE
Middle Name:PUCKETT
Last Name:ROSE
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 1:1414 5TH AVE SE
Mailing Address - Street 2:SUITE I
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4245
Mailing Address - Country:US
Mailing Address - Phone:256-355-7050
Mailing Address - Fax:256-355-7050
Practice Address - Street 1:1414 5TH AVE SE
Practice Address - Street 2:SUITE I
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4245
Practice Address - Country:US
Practice Address - Phone:256-355-7050
Practice Address - Fax:256-355-7050
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1846101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional