Provider Demographics
NPI:1760056949
Name:LONDON, DEIDRE (LPC)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:
Last Name:LONDON
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 1:3035 STONE MOUNTAIN ST UNIT 2122
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-1121
Mailing Address - Country:US
Mailing Address - Phone:470-782-1954
Mailing Address - Fax:
Practice Address - Street 1:617 HILLANDALE PARK DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-8836
Practice Address - Country:US
Practice Address - Phone:404-229-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA009643OtherLPC