Provider Demographics
NPI:1629728225
Name:OWENS, TAMIKO (LPC)
Entity Type:Individual
Prefix:
First Name:TAMIKO
Middle Name:
Last Name:OWENS
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 1:3211 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SOPERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30457-3235
Mailing Address - Country:US
Mailing Address - Phone:478-494-4896
Mailing Address - Fax:
Practice Address - Street 1:3211 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:SOPERTON
Practice Address - State:GA
Practice Address - Zip Code:30457-3235
Practice Address - Country:US
Practice Address - Phone:478-494-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional