Provider Demographics
NPI:1053115824
Name:MENESES, JUSTINE (LMFT)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:MENESES
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S SKINNER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-3221
Mailing Address - Country:US
Mailing Address - Phone:912-349-8043
Mailing Address - Fax:
Practice Address - Street 1:205 S SKINNER AVE STE B
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-3221
Practice Address - Country:US
Practice Address - Phone:912-349-8043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT002171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional