Provider Demographics
NPI:1760791115
Name:JOSEFSBERG, MYRA (LPC)
Entity Type:Individual
Prefix:MS
First Name:MYRA
Middle Name:
Last Name:JOSEFSBERG
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 1:7297 EAST WYNFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820
Mailing Address - Country:US
Mailing Address - Phone:706-568-9401
Mailing Address - Fax:
Practice Address - Street 1:7297 EAST WYNFIELD LOOP
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820
Practice Address - Country:US
Practice Address - Phone:706-568-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004778101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional