Provider Demographics
NPI:1689795973
Name:ROSS, ABRAHAM P JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:P
Last Name:ROSS
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:MORELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30259-0458
Mailing Address - Country:US
Mailing Address - Phone:770-251-0530
Mailing Address - Fax:770-251-8656
Practice Address - Street 1:37 CALUMET PKWY # J
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6734
Practice Address - Country:US
Practice Address - Phone:770-251-0530
Practice Address - Fax:770-251-8656
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001560101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor