Provider Demographics
NPI:1932484060
Name:JUSTICE, ANITA MURDOCK (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MURDOCK
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2728
Mailing Address - Country:US
Mailing Address - Phone:478-314-2450
Mailing Address - Fax:478-314-2419
Practice Address - Street 1:577 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2728
Practice Address - Country:US
Practice Address - Phone:478-314-2450
Practice Address - Fax:478-314-2419
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist