Provider Demographics
NPI:1700020807
Name:PATTERSON, MARLA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:JEAN
Last Name:PATTERSON
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:P.O. BOX 142
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-2166
Mailing Address - Country:US
Mailing Address - Phone:678-545-0498
Mailing Address - Fax:678-545-0746
Practice Address - Street 1:217 ARROWHEAD BLVD SUITE A4
Practice Address - Street 2:THE MILESTONE CENTER
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:678-545-0498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005645101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional