Provider Demographics
NPI:1902232283
Name:SOARES, LORENA (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:
Last Name:SOARES
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S PARK SQ NE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8602
Mailing Address - Country:US
Mailing Address - Phone:770-633-6503
Mailing Address - Fax:678-290-6614
Practice Address - Street 1:120 S PARK SQ NE
Practice Address - Street 2:SUITE 208
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8602
Practice Address - Country:US
Practice Address - Phone:770-633-6503
Practice Address - Fax:678-290-6614
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional