Provider Demographics
NPI:1922465624
Name:HIRSCH, MARLEY RUTH (LPC)
Entity Type:Individual
Prefix:
First Name:MARLEY
Middle Name:RUTH
Last Name:HIRSCH
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 1:3155 MILL STREET
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2542
Mailing Address - Country:US
Mailing Address - Phone:678-712-6520
Mailing Address - Fax:678-712-6521
Practice Address - Street 1:3155 MILL STREET
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2542
Practice Address - Country:US
Practice Address - Phone:678-712-6520
Practice Address - Fax:678-712-6521
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional