Provider Demographics
NPI:1992373120
Name:COLLEEN WALSH, LPC, LLC
Entity Type:Organization
Organization Name:COLLEEN WALSH, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:770-715-2106
Mailing Address - Street 1:4480H S COBB DR SE # 258
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6958
Mailing Address - Country:US
Mailing Address - Phone:404-480-2038
Mailing Address - Fax:
Practice Address - Street 1:50 WHITLOCK PL SW STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3164
Practice Address - Country:US
Practice Address - Phone:404-480-2038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty