Provider Demographics
NPI:1902207913
Name:BEARD, GARDENIA E (MS, LAPC)
Entity Type:Individual
Prefix:
First Name:GARDENIA
Middle Name:E
Last Name:BEARD
Suffix:
Gender:F
Credentials:MS, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PRIME PT
Mailing Address - Street 2:BLDG. 2, SUITE D
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3334
Mailing Address - Country:US
Mailing Address - Phone:678-788-6025
Mailing Address - Fax:888-269-9127
Practice Address - Street 1:211 PRIME PT
Practice Address - Street 2:BLDG. 2, SUITE D
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3334
Practice Address - Country:US
Practice Address - Phone:678-788-6025
Practice Address - Fax:888-269-9127
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004425101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health