Provider Demographics
NPI:1831495670
Name:CHILDERS, JANICE LYNNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:LYNNE
Last Name:CHILDERS
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 1:1620 HICKORY ST
Mailing Address - Street 2:STE 404
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2312
Mailing Address - Country:US
Mailing Address - Phone:706-270-5033
Mailing Address - Fax:706-370-7749
Practice Address - Street 1:320 N RIVER ST NW
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-9408
Practice Address - Country:US
Practice Address - Phone:706-625-8369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006259101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional