Provider Demographics
NPI:1821523531
Name:THAXTON, LINDSAY NICOLE (PHD, LPC, CPCS)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:NICOLE
Last Name:THAXTON
Suffix:
Gender:F
Credentials:PHD, LPC, CPCS
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:THAXTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC, CPCS
Mailing Address - Street 1:3459 ACWORTH DUE WEST RD NW STE 210
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5826
Mailing Address - Country:US
Mailing Address - Phone:678-587-8858
Mailing Address - Fax:
Practice Address - Street 1:3459 ACWORTH DUE WEST RD NW STE 210
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5826
Practice Address - Country:US
Practice Address - Phone:678-587-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health