Provider Demographics
NPI:1790051068
Name:MESSMER, GEORGIA DIANE (LPC)
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:DIANE
Last Name:MESSMER
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 1:2343 VILLAGE DR
Mailing Address - Street 2:MARINERS SUITES O-4
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6633
Mailing Address - Country:US
Mailing Address - Phone:912-322-0413
Mailing Address - Fax:912-322-0413
Practice Address - Street 1:140 LAKES BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6813
Practice Address - Country:US
Practice Address - Phone:912-322-0413
Practice Address - Fax:912-322-0413
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006423101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health