Provider Demographics
NPI:1659056596
Name:VENTRE, STEPHEN REDMOND (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:REDMOND
Last Name:VENTRE
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 1:6744 VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1643
Mailing Address - Country:US
Mailing Address - Phone:770-403-4823
Mailing Address - Fax:
Practice Address - Street 1:6744 VALLEY CT
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1643
Practice Address - Country:US
Practice Address - Phone:770-403-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health