Provider Demographics
NPI:1922506625
Name:NEWBERRY, EMILY HYDE (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:HYDE
Last Name:NEWBERRY
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 1:3090 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2406
Mailing Address - Country:US
Mailing Address - Phone:478-787-3056
Mailing Address - Fax:478-292-5415
Practice Address - Street 1:3090 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2406
Practice Address - Country:US
Practice Address - Phone:478-256-6186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional