Provider Demographics
NPI:1629585005
Name:TARVER, JOSEPH CORY (LPC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CORY
Last Name:TARVER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 IVY NOLE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9711
Mailing Address - Country:US
Mailing Address - Phone:770-378-7952
Mailing Address - Fax:
Practice Address - Street 1:107 COLONY PARK DR STE 700
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2788
Practice Address - Country:US
Practice Address - Phone:770-378-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-06
Last Update Date:2018-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional