Provider Demographics
NPI:1659523009
Name:METELO, LENICE (LPC)
Entity Type:Individual
Prefix:
First Name:LENICE
Middle Name:
Last Name:METELO
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 1:475 BOTTESFORD DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7129
Mailing Address - Country:US
Mailing Address - Phone:404-374-6415
Mailing Address - Fax:866-907-3948
Practice Address - Street 1:181 10TH ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4050
Practice Address - Country:US
Practice Address - Phone:678-310-6631
Practice Address - Fax:866-907-3948
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional