Provider Demographics
NPI:1013679398
Name:LEDBETTER, CONSUELO
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6703
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-6703
Mailing Address - Country:US
Mailing Address - Phone:478-352-9068
Mailing Address - Fax:
Practice Address - Street 1:120 N DUDLEY ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3410
Practice Address - Country:US
Practice Address - Phone:478-957-3532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)