Provider Demographics
NPI:1760993950
Name:BAXTER, CATHERINE (LPC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BAXTER
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 1:2772 N THOMPSON RD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3218
Mailing Address - Country:US
Mailing Address - Phone:770-317-6448
Mailing Address - Fax:
Practice Address - Street 1:4530 S BERKELEY LAKE RD STE B
Practice Address - Street 2:
Practice Address - City:BERKELEY LAKE
Practice Address - State:GA
Practice Address - Zip Code:30071-1657
Practice Address - Country:US
Practice Address - Phone:770-446-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional