Provider Demographics
NPI:1891227542
Name:MAGNUS, LORIEN
Entity Type:Individual
Prefix:
First Name:LORIEN
Middle Name:
Last Name:MAGNUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3465 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7465
Mailing Address - Country:US
Mailing Address - Phone:678-926-9859
Mailing Address - Fax:
Practice Address - Street 1:3465 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7465
Practice Address - Country:US
Practice Address - Phone:678-926-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009289101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional