Provider Demographics
NPI:1629448857
Name:BEARD, NOELLE (LPC)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:BEARD
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 1:412 PEPPERBUSH BND
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-1207
Mailing Address - Country:US
Mailing Address - Phone:404-432-2552
Mailing Address - Fax:
Practice Address - Street 1:412 PEPPERBUSH BND
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-1207
Practice Address - Country:US
Practice Address - Phone:404-432-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional