Provider Demographics
NPI:1689897449
Name:HUNTER, LEA (LPC,MHSP)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:HUNTER
Suffix:
Gender:F
Credentials:LPC,MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 OSBORNE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-8410
Mailing Address - Country:US
Mailing Address - Phone:912-825-8488
Mailing Address - Fax:
Practice Address - Street 1:605 OSBORNE ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-8410
Practice Address - Country:US
Practice Address - Phone:912-825-8488
Practice Address - Fax:912-341-6794
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1920101YP2500X
GA10081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003220921AMedicaid