Provider Demographics
NPI:1639416225
Name:ANDERSON, BILLIE LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:LYNN
Last Name:ANDERSON
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 1:432 HAMPTON GRN
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2712
Mailing Address - Country:US
Mailing Address - Phone:770-631-8229
Mailing Address - Fax:
Practice Address - Street 1:2511 HIGHWAY 34 E
Practice Address - Street 2:SUITE C
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2309
Practice Address - Country:US
Practice Address - Phone:678-423-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006610101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional