Provider Demographics
NPI:1184165698
Name:TOSO, SEANNA (LPC)
Entity type:Individual
Prefix:
First Name:SEANNA
Middle Name:
Last Name:TOSO
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 1:255 CORPORATE CENTER DR STE C
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7376
Mailing Address - Country:US
Mailing Address - Phone:762-499-3403
Mailing Address - Fax:888-406-5175
Practice Address - Street 1:255 CORPORATE CENTER DR STE C
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7376
Practice Address - Country:US
Practice Address - Phone:762-499-3403
Practice Address - Fax:888-406-5175
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009508101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003214786AMedicaid